BLCK (04-3464)Tdf 4 4aU&rw
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . .
04-00003464 Date
4/14/04
Property Address . . . . . .
53925 AVENIDA MENDOZA
APN:
774-172-019-9 -000000-
Application description
WALL/FENCE
Property Zoning . . . . . . .
COVE RESIDENTIAL
Application valuation . . . .
1250
Owner
Contractor
------------=-----------
HANRON CORPORATION
------------- ----------
AJF CONSTRUCTION
112 DON MIGUEL CIRCLE
P.O. BOX 57724
PALM DESERT CA 92260
SHERMAN OAKS
CA 91413
(760) 641-5988
WCC: STATE FUND
WC: 13711632003
10/01/04
CSLB: 787537
11/03/04
CCC: B-HIC
----------------------------------------------------------------------------
Permit . . . . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . . 31.00
Plan Check Fee
.00
Issue Date
Valuation
1250
Expiration Date 4/14/05
Qty Unit Charge Per
Extension
BASE
FEE
15.00
8.00 2.0000 HND BLDG
501-2,000
E`
16.00
Special Notes and Comments
50 L.F. 6.' GARDEN WALL, CITY STANDARD
Fee summary Charged
-----------------
Paid Credited
Due
----------
Permit Fee Total 31.00
------------------------------
.00 .00
.31.00
Plan Check Total .00
.00 .0.0
.00
Grand Total 31.00
.00 ..00
31.00
14 2004��
P.O. BOX 1504
VOICE (760.) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: C? 41 Date: C24
Applicant: . - I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address'
Lic. No.:
t UILUINU PERMIT DECLARATIONS
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
and License is if}Jull force and effect. S3
incense Classss License No.
�itractor
OWNER-81JILDER DECLARATION
I hereby affirm 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 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 the applicant Professions a civil) 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
pp penalty of not more than rive 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 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, howeyer, 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 1 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 self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
othe work for which this permit is issued.
cve 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�o rkers' compensation insu mer and liccyy number
amer `41-1, , r,,&v d. a Number %_-,
_ 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, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
WARNING: FAILURE TO SECURE W6RKERS' 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 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
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 Ouinta, 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 perdt, or
cessation of work for 180 days will subject perm 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 relating to building
construction,
/and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Si W �(Applicantor Agent): r