BLCK (05-3684)P.O. BOX 1504
78-495 CALLE TAMPICO ALIG 0 200
LA QUINTA, CALIFORNIA 92253 __WJLD1NG-�&.SS1_ E Y DEPARTMENT
CITY OF LA
bi G PERMIT
Application Number:-__.�-05--0060_6_84
Property Address: 81340 NATIONAL DR
APN: 767 -570 -004 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3510
Applicant:. Architect or Engineer:
COP
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 fcommencing with
Section.7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License�lassr LicenseNo.: 482086
0
,J-<ontract' r:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Ar�y city or county that requires a permit to
construct, alter, improve, de�irblish, 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 Contractor's 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).:
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 JSec. 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, as owner of the property, am exclusively contracting with licensed contractors to construct the project JSec.
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.).
I I I am exempt.under Sec. _ BAP.C. for this reason
D6te:
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:
LQPIERMIT
VOICE (760) 777�7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/19/05
Owner:
NORMAN ESTATES II
C/O MEDALLIST GOLF DEV . ELOPMENT
501 NORTH AlA
JUPITER, FL 33477
Contractor:
EHLINE COMPANY
55375 MEDALLIST DR
LA QUINTA, CA 92253
(760)771-8130
Lic. No.: 482086
WORKER'S 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 of the work for which this permit is
issued.
_V_ 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 STATE FUND Policy Number 1814972
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
15at*3700 of the Labor Code, I shall forthwith comply with those provisions.
2�� a h /yC_Q1 (�O_ .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS J$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.
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 thi City
of La Quinta, it� 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 they &oe 'nformration is correct. I agree to comply with all
str
city and county ordinances and state laws relating to buil ing o struction, and her by uthorize representatives
c
ct,
of thi y t enter upon t above-mentioned prope . r i sp tioyurposes
date:b, Signature (Applicant or Agent):
LQPERMIT
Application Number 05-00003684
Permit . . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 63.00
Plan Check
Fee
.00
Issue�Date
Valuation
. . .
. 3510
Expiration Date 2/15/06
Qty Unit Charge, Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU- BLDG
2,001-25,000
18.00
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Special Notes -and Comments
134 L.F. 61 GARDEN WALL, &.10 L.F.
41
GARDEN WALL, BOTH CITY STANDARD
Fee summary Charged
Paid Credited
Due
-------------- ----------- ----------
Permit Fee Total 63.00
----- -----------------
.00
.00
63.00
Plan Check total .00
.00
.00
.00
Grand Total'
.00
.00
6�.00