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BLCK (05-5230)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 1-05-00005230 _ _ Property Address: 81100 NATIONAL DR APN: 767=600 -002 - Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 1000 Applicant: Architect or Engineer: `1 - •4 ��VIN BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 _ FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: NORMAN ESTATES II C/O MEDALLIST GOLF DEVELOPMENT 501 NORTH AlA JUPITER, FL 334 Contractor: EHLINE COMPANY 55375 MEDALLIST LA QUINTA, CA 9 (760)771-8130 Lic. No.: 482086 Date: 11/29/05 ------------------------------------------------- LICENSED'CONTRACTOR'S DECLARATION - ----------------------------------------------— I WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that4 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 Busi 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: 13 1 se No.: 482086 for by'Section 3700 of the Labor Code, for the performance of the work for which this permit is Date: ntracto . issued. Y 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 Q R -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I area, from the Contractor's State License Law for the Carrier STATE FUND Policy Number 1814972 ' 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 beco csltbject 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 3770 of thg1.abor Code, I shal for with comply ith th a rovisions. 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).: ate:V plicant: (_ 1 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 WARNV AI URE TO SECURE WORKERS' COMPENSA 0 COVERAGE 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 CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS 15100,0001. IN ADDITION TO THE COST OF COMPENSATION, 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 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 contractors) 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 I am exempt under Sec. , B.&P.C. Jor this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City Date: Owner: 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: Lender's Address: rx LQPERMIT of La Quinta, its officers, agents and employees for any as 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 willsubject permit to cancellation. I certify that I have read this application and state that the abo information is correct. I agree to comply with all city and cou ty ordi noes and state laws relating to buil ' g c struction, and hereby authorize representatives of�this cou y77to en r upon bove-mentioned prop y f inspection p po - �ature (Applicant or Agent): LQPERM[T Application Number . . . . . 05-00005230 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 25.00 Plan Check Fee 00 Issue Date Valuation 1000 Expiration Date 5/28/06 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 2.10000 HIND BLDG 501-2,000 10.00 ----------------------------------------------------------------------------- Special Notes and Comments 40 L.F. 6' GARDEN WALL, CITY STANDARD Fee summary Charged ---------- --- Paid Credited Due ----------------- Permit Fee Total 25.00 .00 .00 25.00 Plan Check Total .00 .00 .00 .00 Grand Total 25.00 .00 .00 25.00 LQPERM[T