04-3538 (BLCK)C
BUILDING &.SAFETY DEPARTMENT
P.O. BOX 1504 (7.60) 777-7012
78-495 CALLE'TAMPICO FAX (760) 777-7011
LA .Q.UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . .
0-4=00003"53-8- Date 4/16/04
Property Address
49500 ALI CT-`
APN:
649-520-01.4-24 -290532-
Application description . . .
WALL/FENCE
`Property Zoning
LOW DENSITY RESIDENTIAL
Applicatio.n'valuation
1000
Owner
Contractor
PM RENAISSANCE, LLC
TRANS WEST.HOUSING,
INC.
9968 HIBERT STREET, 'STE: 102
9968 HIBERT STREET;
STE #102
SAN DIEGO CA 92.131
SAN DIEGO
CA 92131
(858) .653"73003.WCC:
' . .... STATE FUND
WC,:.. 164881:;...
10%.0.1/04 .
.. .'
CSLB:-.'..,,;701039.:::;- .,'
01/31/05
CCC
.
Permit WALL/'FENCE
PERMIT
Additional desc
Permit Fee 25..00
Plan Check . Fee.:.
.00
Issue Date. . . .
Valuation'
1000
Qty Unit. Charge Pere
Extension
BASE.FEE
15.00
5.00 2.0000 HND. `BLDG
501-2,000
10.00
Special Notes and Comments
40 L.F..6' PROPERTY''LINE WALL;
ORCO
SYSTEM
Fee .summary Charged.
Paid Credited
Due
.`.Permi.t.Fee Total :.: 25.00
.00 ...'0 0
25.00
Plan Check Total 00
00 0'0:: _ : `
00
Grand Total. 25..00'.
00' .00.
25.00
11111 III 11111
IN 07
IE
P.O. BOX 1504 QUW4
VOICE (760) 777-7012
78-495 CALLS TAmpico FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. - O �,38 Date: S/-
Applicant: I Architect or Engineer.
Applicant's Mailing Address:
Architect or Engineer's Address:
Uc. No.
BUILDING PERMIT DECLARATIONS .
1 hereby strum under LICENSED CONTRACTOR'S DECLARATION
penalty of perjury that I am ficensed under provisions of Chapter 9 (oarinenring with Section 7000) of Division 3 of the Business ane Professionals
and my License WI force and affect.
License Class No, %O/ 0
Date - I � N (i✓e3 t�Us/iva
1 hereby strum under penally of perjury that I am owNER-BUMDER DECLARATION
from the Contractors' State License Law for the k1lowing reason (Sec. 7031.5. Business and Professions Code: Any
city or county UW requires a permit 10 construct atter. knprove, demolish, or repair any structure, pnior to its issuance. also requite the applicant for the permit to file a signed
statement that he or she is kersed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom andthe basis for the alleged exemption. Any violation of Section 7031.5 by any appfirer I for a permit subjects
the applicant to a civilpenalty of not hoe than" hundred dollars ($500).):
. U 1, as owner, of the property. or my employees with wages as thele 9018 compensation. will do the wok, and the sbucture Is not intended or offered for sale (Sec. 7044,
Business and Profession Code: The Cahtredors' State License Law does not apply to an owner of property who builds or improves thereon. and who does the work
himself or herself or through his or her own employees, provided that the Improvements are not intended or offered for sale. If. however, the building or irptovement is
sold within one year of completion: the owner-bi lder wig have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I. as owner of .the property. am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Cade: The Contractors'
State License Law does not apply to an owner of property who builds or improves themon and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under sec. . 8.3 P.C. for this reason
Date. Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to seg -Insure for workers' corpensation, as provided for by Section 3700 of the Labor Code. for the performance
of the wok for whidh this permit Is issued.
1 have and will maintain workers' compensation insurance. as
�r conmmperh �1regquir {eKdm�by Section 3700 of the Lebo Code. for the performance of the work for which this permit is
�anYter � t !O L NIS ' sabon��p,� Number and
�7r n�`d`r
_ I certify that, In the performance of the wale for which fun permit k issued. l shag rat employ any person in any manner so as to become subject to the workers'
compensation laws of California. and agree that If 1 should become subject to the workers' compensation provision of Section 3700 of the Labor Code. I shag
fontmwfth.compty with those provisions•
,,--Date -�,--A—pp*ficwt
WARNING: FAILURE TO SECURE WORKERS' TION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FtNES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. .
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is a eorshuctioh lerd'mg agency for the performance of the wok for which this permit is issued (Sec. 3097. Civ. C.).
Lenders Name
Lenders Address
APPLCANT ACKNOWLEDGEMENT
IMPORTANT
Application Is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1- Each person upon whose behalf this application is made. each person at whose request and for whose benefit wok is performed under or pursuant to any permit
Issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of Le Oudnta, Its
officers, agents and employees for any ad or omission related to the work being performed under of following issuance of this permit
2. Any permit issued as a If of this application becomes null and void wok is not commenced within 180 dalys from date of issuance of such permit, or
cessation of wroh for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above Information is correct I agree to comply with all city and county ordinances and state laws relating to building
construction. and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Vita e �r 2 Ct_y ill— nature (Applicant or Agent): "Og4 le rzw�,