BLCK (05-3686)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: "705 -00003686 -
Property. Address: 81380 NATIONAL.DR
APN: � - 767 -570 -006 -
Application deschption: . WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3510
Applicant:
Tity/ 4 4 Q"
Architect or Engineer:
PIA
BUILDING & SAFETY DEPARTMENT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Owner:
NORMAN ESTATES II
C/O MEDALLIST GOLF DEVELOPMENT
501 NORTH AlA
JUPITER, FL 33477 -
Contractor:
EHLINE COMPANY
5S375 MEDALLIST DR
LA QUINTA, CA 922 53
(760)771-8130
Lic. No.: 482086
Date: 8/19/05
7.
SEP - 0 8 2005 0;,
ZI—Ty _0� � QUINTA
----------------------------------------——-- 7 —---------—--------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
of officers a ants omission related work
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of pejurAhal Inadmplicensed Under provisions of Chapter 9 icommencing with
I hereby affirm under penalty of perjury one of the following declarations:
act of the" . __
S ion 7000) of Division 3 rofessionals 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 as B Licens9pNo.: 482086
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
,, �Date. 8 SI-Contractov
�A
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
OWNER'BUILDER 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. 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 sn 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 sh ild ecome 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 t��abo' C I all forthwith
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
vz,4 ��provisions.
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)
pplicant:
1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
�ate:
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARN 1.11612RE'TIPSECURE WORKERS' COMPENSITION 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 J$100,000). 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, as owner of theproperty, 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 contractor(s) licensed
1. Each person upon whose behalf this application is made, each.perSon at whose request and fo r
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,
I I am exempt under Sec. _, B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
La Qui ta its -i I ; f t to the bein
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:
LQPERMIT
n 9 an empoyee or any ac or 9
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 tl�79ove information is correct. I agree to comply with all
ng to bu .
city and county ordinances and state laws relati truction, an4tereby authorize representatives
:of this p r i spection purpVes.
_1,4 y enter upon t Idbove-mentioned pro
t�e: , gnature (Applicant or Agent:I_�M�
LQPERMIT
Application Number 05-00003686
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. 4.1
GARDEN WALL, BOTH CITY STANDARD
Fee summary Charged Paid
Credited
Due
----------------- ---------- ----------
Permit Fee Total 63.00
---------- --7
.00 .00
-------
63.00
Plan Check Total .00
.00 .00
.00
Grand Total 63.00
.00 .00
63.00