BLCK (07-3012)P.O. BOX 1504
78-495 CALLE'TAMPICO
--LA QUINTA; CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT
Application Number:
.i
07?0000.3- .10-0-0:3 0-1-2----*
LICENSED CONTRACTOR'S DECLARATION
Property Address:
79721 MISSION
DR E
AP.N:.
602-180-999-C
-2945747
Application description:
WALL/FENCE
License Class: C29 ense No.: 446180 -
J Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
3789
issued.
---> Date: r Contractor:
Applicant:.
- I
Architect or Engineer:
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUIL ER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Owner:
T D DESERT DEV
P O BOX 1716
LA QUINTA, CA
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/04/07
92253
Contractor:
BARAJAS MASONRY,
42901 LIMA HALL
INDIO, CA 92201
(760)345-3912
Lic. No.: 446180
R
Date:
Owner:
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.).'
r Lender's Name:
+i1 Lender's Address:
Al
1
LQPER 11T
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=above information is correct. I agree to comply with all
city and county ordinances and state laws relating.to building co _ e�Fh a representatives
of this co my to enter upon the above-mentioned property for i ose
•
\ Dat- O Signature (Applicant or Agent):
LICENSED CONTRACTOR'S DECLARATION
-------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C29 ense No.: 446180 -
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is '
j�
�5/
issued.
---> Date: r Contractor:
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
- I
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUIL ER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 0006493-2007
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the'workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I.s f with - with those provisions. -
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
�J
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.:
Date Applicant:
Applicant:
(_ 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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIOOVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License. Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVI INES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO.THE COST OF COMP SATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.):
APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project ISec.
IMPORTANT Application is hereby made to the Director of Building. and Safety for a permit subject to the
• 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects.with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
1 _ 1 I am exempt under Sec. , BAP.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
Date:
Owner:
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.).'
r Lender's Name:
+i1 Lender's Address:
Al
1
LQPER 11T
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=above information is correct. I agree to comply with all
city and county ordinances and state laws relating.to building co _ e�Fh a representatives
of this co my to enter upon the above-mentioned property for i ose
•
\ Dat- O Signature (Applicant or Agent):
Application Number. 07-00003012
Permit WALL/FENCE PERMIT
.. Additional desc .
Permit -Fee . . . 63.00
Plan Check
Fee
.00
Issue Date
Valuation
.
. 3789
ra Expiration Date 6/01/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00 9,.0000 THOU BLDG 2,001-25,000
18.00 .
-----------------------------------------.
Special Notes and Comments
175LF RETAINING WALL [ENGINEERED] -
100LF AT 51H / 75LF AT.3'-41-H LOCATED
ON
PROPERTY LINE _ 2001 CBC.
December 4, 2007 3:10:'20 PM AORTEGA
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
.00 ..00.
63.00
LQPERN11T