06-3755 (BLCK)54455 Alysheba Dr
4A
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08
IE
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00003755
54455 ALYSHEBA DR
767-320-999-54 -32879 -
WALL/FENCE
LOW DENSITY RESIDENTIAL
9850
T-i&t 4 4 a"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSEDD CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed un ,r provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the 13Tss and Professio 'Code, and my License is in full force and effect.
License C : B ense No.: 701039
te: ZO ntractorJriury
O ER -BUILDER DECLARATION
I hereby affirm under penalty of pat I amexempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Bnd Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's 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 and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.:
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPE%NIIT
Owner:
MCCOMIC GRIFFIN LLC
7979 IVANHOE AVE #550
LA JOLLA, CA 92037
Contractor:
TRANS WEST HOUSING, I
9968 HIBERT STREET, S
SAN DIEGO, CA 92131
(858)653-3003
Lic. No.: 701039
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/23/06
102
oCT 252006
,
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1648813-2006
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become su ' ct to the workers' compensation laws of California,
and agree that, if I s Id become subje to the workers' compensation provisions of Section
0 of the Labor Co , I shall fo comply with those Provisions.
ate: 7 d6 licant:
WARNING: FAILURE TO SECU WOR ERS' OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO C [MIN PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDUC THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT 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 work 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 La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state tt t the above infor n is. correct. I agree to comply with all
city and county ordinances and state laws relating t building constr i , and hereby authorize representatives
of this coun to enter upon the abov -mentioned p erty for insp urposes. -
D 1l V j
Sig re (Applicant or Ag [I:
4 -64
Application Number . . . . . 06-00003755
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 117.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
9850
Expiration Date . . 4/21/07
Qty Unit Charge PerExtension
BASE
FEE
45.00
8.00 9.0000 THOU BLDG
----------------------------------------------------------------------------
2,001-25,000
72.00
Special Notes and Comments
394 L.F. 6' GARDEN WALL AT REAR
& SIDE
YARDS, ORCO SYSTEM
Fee summary Charged
-----------------
Paid
Credited_
Due
---- ----- -L--------
Permit Fee Total 117.00
---=------
.00
----------
.00
117.00 '
Plan Check Total .00
.00
.00
.00
Grand Total 117.00
.00
.00
117.00
LQPER1N11T