TT (13-1126)P.O. BOX 1504
78-495 CALLE TAMPICO
LA'QUINTA, CALIFORNIA 92253
Application Number: 13-00001.126
Property Address: 81506 MERV GRIFFIN WY
APN: 76.7-320-999-30 -32879 -
Application description: TEMPORARY. TRAILER
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 500'
Applicant. Architect or Engineer:
d-
LICENSED CONTRACTOR'S DECLARATION ,
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
IOTA GRIFFIN LLC.
81-506 MERV GRIFFIN WY
LA^ QUINTA, CA 92253
Contractor:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/09/13
LENNAR HOMES OF CALIFORNIA INC
980 MONTECITO.DRIVE, STE 30
CORONA, 92879" D
ll��V�I (915)•817-3-3600-
Lic."No.: 728102
Ihereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with'
Section 7000) of Division 3 of .the Busines and Professionals Code, and my License is in full force and effect... ,
License dass:1 BQp�/� License No.: 728102
Date. \C Contractor:
OW ER-BUILDER'DECLARATION -
I hereby affirm under penalty of perjury that I am ex pt from the Contractor's State License Law for the
following reason ISec. 7031 .5, Business and. Profess ns Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any stru ture, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he -or she is licen ed pursuant to the provisions of the Contractor's State
License.Law (Chapter 9 (commencing with Section 70 0) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for alleged exemption. Any violation of Section 7031•.5 by
any applicant for a permit subjects the applicant to civilpenalty of not more than five hundred dollars ($500).:
(_ 1 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 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.).
(_ 1 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 I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
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 fSec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
I
SPO Q o
- — - ---
— - — — — — WORKER'S COMPENSAT — . -C R �^ 4AQ(IINT� — —
,I hereby affirm under penalty of perjury one of the following declarations: HHRH E
_ I have and will maintain a certificate of consent to self-ihsure for workers' co Dn, as provide
for by Section 3700 of the Labor Code, for the performance of the work for which this 's
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 OLD REPUBLIC IN ' Policy Number MWC30017800
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 0come subject to the workers' compensation provisions of Section
3700 of the Labor ode, I shall forthwith comply with those provisions.
v 1
oate:�Applicant: 1
WARNING: AILURE'TO SECURE WORKERS' COMPE SATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES D CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST F COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AN ATTORNEY'S FEES. .
APPLICAN ACKNOWLEDGEMENT -
IMPORTANT Application is hereby -made to the Directo 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-an"y 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
permitto cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city an county ordinances and state laws relating to buildin onstruction, and hereby authorise representatives
of this ,n y t4gnter upon the above-mentioned pr erty o ms tion purposes.
Date - SSignature (Applicant or Agent)'
Application Number . . . . . 13-00001126 "
Permit . . . SPECIAL INSPECTION
,
Additional desc .
Permit Fee . . . . 250.25 Plan Check.Fee
.00
Issue Date . . . . Valuation
500
Expiration Date 3/08/14
Qty Unit Charge Per
Extension
1.00 71.5000 EA. MISC SPECIAL INSPECTION
71.50
1.00 178.7500 EA MISC SPECIAL INSPECTION, PC
178.75
-------- - - - - - -
Special Notes and Comments
TEMPORARY CONSTRUCTION TRAILER (12FT X
60FT) PER MUP 2013-1063. TRAILER MUST
MAINTAIN 20FT FROM REAR PROPERTY LINE.
LQMC 9.60.120
Fee summary Charged Paid Credited
Due
Permit Fee Total; 250.25 .00 .00
250.25
Plan Check Total .00 .00 .00
.00
Grand.Total 250.25 .00 .00
250.25