07-2681 (BLCK)Applicant:
Tit!t 4 4 Q"
Architect or Engineer:
4-
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CORAL OPTION I
79295 RANCHO LA QUINTA DR
LA QUINTA, CA 92253
Contractor:
TD DESERT DEVELOPME
P O BOX 1716 D
LA QUINTA, CA 92247
(760)771-1941 r
Lic. No.: 762987 I
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/03/07
e Ij�
OCT 10 2001 L
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LICENSED CONTRACTOR'S DECLARATION
1111111
VIII
III
VIII
IIII 03
,,,P. �OX 1504
IE
t.r
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07-00002681
Property Address:
81631 ANDALUSIA
APN:
764-200-999-55 -316813-
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
4275
Applicant:
Tit!t 4 4 Q"
Architect or Engineer:
4-
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CORAL OPTION I
79295 RANCHO LA QUINTA DR
LA QUINTA, CA 92253
Contractor:
TD DESERT DEVELOPME
P O BOX 1716 D
LA QUINTA, CA 92247
(760)771-1941 r
Lic. No.: 762987 I
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/03/07
e Ij�
OCT 10 2001 L
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LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business an 'onals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License CI s : 139, License No.: 987
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
e: OlJ ntractor:
ssued.
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier COMPIRESTPolicy Number CA005001482003
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
- and agree that, if I should bec 'act to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
700 of the Labor Code tall forthw h comply wit provisions.
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 ($500).:
ate ii! plicant:
(_ 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWF L, AND SHALL
' Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN RED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES S PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
1 _ I I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
'
of La Ouinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
Date: Owner:
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the abov rrect. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and co my rdinances and state laws relating to buil constructionauthorize representatives
lanhereby
of this o myo enter upon the above-mentioned pr rty for inspection p.
Lender's Name:
at�i S' ture (Applicant or Age
Lender's Address:
LQPERMIT
� Y Application Number . . . . : 07-00002681
Permit .. . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee 72.00
Plan Check
Fee
.00
Issue Date . . .Valuation
. . .
. 4275
Expiration Date .'. 3/31/08
Qty Unit Charge Per
Extension
BASE
FEE
45.00
3.00 9.0000 THOU BLDG
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2,001-25,000
27.00
Special Notes and Comments
171 L.F. 6' GARDEN WALL, PROTO SYSTEM
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 72.00
.00
.00
72.00
Plan Check Total .00
.00
.00
..00
Grand Total 72.00
.00
.00
72.00
LQPERMIT