07-2690 (BLCK)1111111 VIII III VIII (III 41
ET44t 4
*0. BOX 1504 v
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: '
Property Address:
APN:
Application description:
Property Zoninq:
Application valuation:
Annlir•anr-
07-00002690
81703 ANDALUSIA
764-200-999-64 -316813-
WALL/FENCE
LOW DENSITY RESTDRNTIAL
4200
Architect or Engineer:
alp
-----------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 Division 3 of the Busine fessionals Code and my License is in full force and effect.
License C ss: Li se 762987
ago 0F!,0 ntracr:
OWNER -BUILDER DECLARATIO
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason ISec. 7031.5, Business and 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 1$5001.:
(_ I 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.).
(_) 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 1 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 ISec. 3097, Civ. C.).
Lender's Name:
Lender's Address: tr
LQPER IIT
Owner:
CORAL OPTION I
79295 RANCHO LA QUINTA DR
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/03/07
Contractor: M:CFITYOF
TD DESERT DEVELOPMENTP O BOX 1716102007LA QUINTA, CA 92247(760)771-1941
Lic. No.: 762987 LAQUINTA
------------------
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 COMPWEST Policy Number CA005001482003
_ 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 the workers' compensation laws of California,
a agree that, if I should bec bject to the workers' compensation provisions of Section
00 of the Labor Code all forth ' h comply ose provisions.
D A cant:
WARNING: FAI RE TO SECURE WORKERS' COMPENSATION COVERA WFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE UNDRED THOUSAND
DOLLARS 15100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMA ES 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 . Eacb 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 the above information is correct. I agree to comply with all
city and co my rdina�ces and tate laws relating to bu' co ruction, and hereby authorize representatives
of this co ty enterpo a above-mentioned pr etty for insp -tion purposes.
D e: gnature (Applicant or Age
Application Number . . . . . 07-00002690
Permit . . . WALL/FENCE
PERMIT
Additional desc . .
Permit.Fee . . . . 72.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 4200
Expiration Date 3/31/08
Qty Unit Charge Per
Extension.
BASE
FEE
45.00
3.00 9.0000 THOU BLDG
2,001-25,000
27.00
----------------------------------------------------------------------------
Special Notes and Comments
168 L.F. 6' GARDEN WALL, PROTO SYSTEM
Fee summary Charged
-----------------
Paid Credited
----------
Due
---------- -7
Permit Fee Total 72.00
-------- ----------
.00
.00
72.00
Plan Check Total .00
.00
.00
.00
Grand Total 72.00
.00
.00
72.00
a
LQPERMIT