06-3754 (BLCK)54515 Alysheba Dr
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E 4 4 Qum&
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
06-00003754
Property Address:
54515 ALYSHEBA DR
APN:
767-320-999-55 -32879 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
. 9250
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed un r provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Bu iness and Profession /Code, and my License is in full force and effect.
License Cla s: B cense No.: 701039
ate: I 'Class:
,Z iZOC ractor:
O ER -BUILDER DECLARATION
I hereby affirm under penalty of erjury hat I am xempt from the Contractor's State License Law for the
following reason ISec. 7031 .5, sin s and Professions Code: Any city or county that requires a permit to .
construct, alter, improve, demolish, r 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 1$500).:
1 _ 1 1, 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 _ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Seca
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.).
(_) 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:
LQPERAtIT
Owner:
MCCOMIC GRIFFIN L
7979 IVANHOE AVE
LA JOLLA, CA 9203
Contractor:
TRANS WEST HOUSIN,
9968 HIBERT STREE ,
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
oiCT z s sous IL
IN&1N OF LA
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 subject to th orkers' compensation laws of California,
and agree that, if,4shuldbecome subject to the rkers' compensation provisions of Section
370 of the Labshall forthwith co with those provisions.
v:
WARNING: FAILURE TO SECURERS' COMP NSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRPENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITHE 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 that he above information is cor I agree to comply with all
city and county ordinances and state laws relating to b ding construction, and reby authorize representatives
of this c/fouy to e ltGr upon the above-mentioned grope or inspection pur es.
Date:- 0 TS d Si ore (Applicant or Agent)'
Application Number . . . . . 06-00003754
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 117.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 9250
Expiration Date . . 4/21/07
Qty Unit Charge. Per Extension
BASE FEE 45.00
8.00 9.0000 THOU BLDG 2,001-25,000 72.00
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Special Notes and Comments
370 L.F.'6' GARDEN WALL AT REAR & SIDE
YARDS, ORCO SYSTEM
Fee summary Charged Paid Credited Due
------------------------------------- - -------- ----------
Permit Fee Total 117.00 .00 .00 117.00
Plan Check Total .00 .00 .00 .00
Grand Total 117.00 .00 .00 117.00
LQPERil9IT
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