BLCK (04-5346)77270 Loma Vista
04-5346
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLS TAMPICO. FAX (760) 777-7011
LA .QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number
---04---0-0-00-5-34-6------"Dater 7/0'2/04
Property Address . .
. . . 7727-0--LOM7V__VISTA
APN:
658-200-013-19` -252.37
Application description description
WALL/FENCE
Property Zoning..
LOW DENSITY RESIDENTIAL
Application valuation
'8500
Owner
Contractor
-----------------------
ALBERTINI SHIRLEY A
SOUTHERN AILLS'.DEVELOPMENT INC
:3355 IIIA. LIDO. NO. 360
8:1070. CHANTICLEER. DR
. ;.
NEWPORT ;BEACH .. ..CA
926.63 . LA. QUINTA
CA' 92253
(760).771-3.497.
.:WCC::. EXEMPT .
WC:: . EXEMPT
0 5./ 31 / 0,5
CSLB:.." 8.38041...
05/31/.06'.
CCC:': B.'.
Permit
WALL/FENCE.±PERMIT
Additional desc
Permit Fee
108.00 Plan Check Fee
:00.
Issue Date . . . .
Valuation
8500
Qty Unit Charge
Pere.:
Extension
BASE FEE
45.00
7.00 9.0000
THOU BLDG 2,001.-25.,000
t, 63..00
Special .Notes and Comments t
340LF 6' GARDEN BLOCK
WALL, ORCO
STANDARD
`
F.ee: summa ry. Cha
rged'.Paid Credited
Due
---=-----------------------
Permit Fee Total
----------------' ----=--------
108.00. ._00 .00
108.00
Plan Check Total
..00 00 ,00
00
Grand Total
108:00 00 .00
108.00
P.O. BOX 1504T10(f 4 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Ssl all GL4.ANT►cLc:e,2
LA QhrL1 Ar , n tip. gz2s'' 3
VOICE(760).777-7612
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date_ :
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and.. Professionals
Code, and my Lioeis in full force 8nd effect.l
License Class License No. O
Date -^ 4 - O `i Contractor S 011'ii'&AA) A 1 LLS f?,f ✓ '
I herebyaffirm under OWNER -BUILDER DECLARATION
penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve. demolish. or repair any stricture, prior to its issuance, also
requires the appricent for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 70W) 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. ($500).):
U 1, as owner of the property, or my employees with wages es their sole compensation, will do Cie work. -and the stricture 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 or 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.).
U 1, 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 conlrector(s) licensed pursuant to
the Contractors' State license Law.).'
.0 I am exempt under Sec. r . B.& P.C. for this reason
Date Owner.
1 hereby affirm under penally of WORKERS' COMPENSATION DECLARATION
perjury one of the following declarations: ,
— I have and will maintain a certificate of consent to selfinsure 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..
—1 have and wi .mai in rkers' compensation insurance, as required by Section 3700 of the Labor Code. for the performance of the work for which this permit is
issued• wo cation insurance carrier and policy number are:
Carver Policy Number
— I certify I mhance 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'
compe on ws f CarIorn and agree that. should subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall
forthwith . y with those provisions:
Date-2-L5—( L Applicant
WARNING: FAILURE TO SECURE WORKERS C MPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUS DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN .
SECTION 3706 OF THE LABOR CODE, INTE ST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 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
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.
I. Each person upon whose behalf this application is made, each person at whose request and for whosebenefit 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 tt)e work being performed under or following issuance of this permit
2. Any pertmit 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 county ordinances and state laws rotating to building
construction, and hereby authorize. representatives of this county to enter u the n property for inspection purposes.
Date . '+ '7 ' O Signature (Applicant or Agent): . Q j