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BLCK (04-5164)55335 Medallist Dr 04-5164 BUILDING & SAFETY DEPARTMENT P.O. Box 1504. - (760);777-7012 F ¢18-49,5,1, CALLE TAMPIC.O h tl FAX (760) 777-7011 QU LA INTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153 . BUILDING PERMIT App"1"iFcatio:n--Number• . . X0.4 -0-0005164-x. Date 6/25/04 . P:roper.ty.Address 55335 MEDALLIST DR APN: 767-510-004,- - Application description WALL/FENCE Property Zoning LOW DENSITY RESIDENTIAL. AppTication.valuatio' 3945. Owner Contractor NORMAN ESTATES II EHLINE.COMPANY. MEDALLIST GOLF DEVELOPMENT-. 5:5375.MEDALLISTDR. 501 .NORTH .AlA.. LA .QUINTA CA.'92253 JUPITER FL 3347:7 :(760) .771:-8130 WCC.: STATE. FUND.: CS 22900'06783 01./,01/-05 . LB• 482:086 11/30/05,. :. cc:: B Permit WALL/FENCE PERMIT ` .Additional desc Permit Fee 63.00 Plan Check.Fee* .00 Issue Date Valuation.:. 3945 Qt Uni;t-Charge..Per Extension Qty . BASE FEE. 45.00 2-00. 9.0000 THOU.- BLDG . 2; 0 0.1 2'5., 0.0.0 1, 8. 0 0 _.__.-.--------------.----- Special Notes and Comments 20'L.F. 3' BLOCK WALL, 145 L.F. 6' BLOCK WALL, BOTH ORCO SYSTEM. Fee summary Charged Paid Credited. Due Permit -Fee Total 63::00. -00 ,.00 .63.00 ~Plan Check:Total 00 -.00:00 ..00 Grand Total 63-.00 0Q.. .00. 63.00 P.O. Box 1504 78-495 CALLE TAMPICO TAU.-oo LA QUiNTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT VOICE (760) 7.77-7012. FAX (760) 777-7011 INSPECTIONS (76.0)'777-7153 Application Number: /(o Date: 10 - s .- O y Applicant: I Architect or Engineer. Applicant's Mailing Address: Architect or Engineer's Address. Lic. No.: 6/-A BUILDING PERMIT.DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that'l am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business'and Professionals Code, and my Licejpe is in full force and effect. `n License Class _!i Ucense No. Dateb _0 Contractor OWNER -BUILDER DECLARATION 1 hereby affirrn'under 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 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 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).): L j I; 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 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 contractors) 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 hereby affirm under penalty of perjury one of the following declarations:. I have and will maintain a certificate of consent to selfansure 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 ,,j ed. My wodcers' co pensation yossu rarence cavig ar d p 1[cynum er er _ / '% n, Policy Number L. -`7't t C) _ 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, n agre that, If I should become subject to the workers' compensation provisions of Section 3700 of the Labor code, I shall forthwith comply with those pro sl s 'e DaA/pplican WARN NG: 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 Lenders Address 103 4bl- 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 the ajInfoUon Is correct 1 agree to comply with all city and county ordinances and state laws relating to building constraction, and hereby authorize representatives of this cr pon the above menlloned property for inspection purposes. Si (Applicant or Agent)