BLCK (04-3385)50440 Los Verdes Way
04-3385
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760) 777-7012
78-495 CALLE TAMPICO FAX (760).777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS.(760) 777-7153
Application Number
Property Address . . .
APN:
Application descriptio
Application valuation .
Owner
BUILDING PERMIT
04-00003385 Date..' 4/09/04
. . . 50440 LOS VERDES WY
772-250-999-99 -30357 -
n WALL/FENCE
1525
TOLL CA V
C/O -KEVIN D DUERMIT
8901E MOUNTAIN VIEW 200
SCOTTSDALE AZ 85258
Contractor.
------------------------
TOLL BROS INC.
73121 -FRED WARING DRIVE, ##100
PALM DESERT CA 92260
WCC:*ROGAL.& HAMILTO
WC:. WA264DO0472301.09/01/04
CSLB: 777699. 04/30/06
CCC ..B
Permit WALL/FENCE PERMIT.
Additional desc
Permit Fee 37.00 Plan Check Fee .00
Issue Date Valuation 1525
Qty Unit Charge Per Extension
BASE FEE 15.00
11.00 2.0000 HND BLDG 501-2,000 22.00
Special Notes.and.Comments
61 LF 6' GARDEN WALL, ORCO SYSTEM, PER
APPROVED PRECISE.
Fee summary Charged Paid Credited. Due.
Permit Fee Total .37.00. 00 0.0. 37.00
Plan Check Total .00 .00 .00 .00
Grand Total 37.00 .00 .00 37.00
U
APR 2 0 1004 ..
CITY OF LR ni jtm . I
ff
P.O. BOX 1504
G1 / VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS=(760) 7.77-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Date:
Applicant:
Applicant's ailing Address:
Lic. No.: r!
BUILDING PERMIT DECLARATIONS
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
I 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, Lice is in full force and effect
License Gass License No. C S? '77 b q C/
Date 4 l?.Dl 0 4 Contractor 'Cb l 4 ro +-h $ r s
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason.(Sea 7031.5, Business and Professions Code: Any
city or county that requires a permit to constrict, 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 Contractors' State License Law (Chapter 9 (commencing' with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she los exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a pernit 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 as their sole compensation, will do the work, and the stricture is not intended or offered for sale (Sea 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 contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self4nsure 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 maintainworkers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. M workers' comlpgnsation insurance carrier and policy number are:
Cartier 20!34 P P(407r /FO POlicyNumber WA ?(.o4 D064? 3 n
_ I % rtify 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 Catifomia, and agree that, If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code,1 shall
forthwith comply with those provisions.
Date f I 20M 4 Applicant_ D 9 ;V04 h, sYS
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, 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.).
Lendefs 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.
1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is perforated 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 Omnia, 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 O 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.
1 certify that 1 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 relating to building
constriction, and hereby authorize representatives of this county to enter upon t e above-mentioned property for inspection purposes.
Date 412-010 4- Signature (Applicant or Agent):