BLCK (05-0069)v
Of
BUILDING & SAFETY DEPARTMENT
1504
(760).777-7012
FTt 78- ALLE TAMPICO ,. FAX (760) 777-7011
I
LA Q A, CALIFORNIA
92253 INSPECTION REQUESTS (760) 777-7153
JAN 07 2005..
BUILDING PERMIT
CITY T�
ANCE DEP
.�
Application Number
C1 .05-00000069 Date.' 1/07/05
Property Address . . .
. . . 78500 MILES AVE
APN:
604-032-0097 -000000-
Application description
WALL/FENCE
Property Zoning . . . .
. . . ,LOW DENSITY RESIDENTIAL.
Application valuation
352
.Owner
Contractor
LENNAR HOMES OF CALIFORNIA
LENNAR HOMES OF CALIFORNIA INC
78401. HIGHWAY 111, STE C
78401 HIGHWAY 111, SUITE C
LA QUINTA, CA
LA QUINTA, CA 92253
LA QUI -NTA;' CA 92253
(951)817-3600
WCC: AON RISK SRVC
WC: .MWC11114500 . 11/01/05
CSLB: 728102 09/30/06
CCC: B
P.O. BOX 1504 •
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: 05-- 0061
.Applicant:
Applicant's Mailing Address:
DIV-,
Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
Architect or Engineer's Address:
Lic. No.:
011,111LIANIi PERMIT DECLARATIONS
n) /A
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000)'of Division 3 of the Business and Professionals
C de, and my Licens s in full force and effect. '�1 `'l
censeiClassI (� icense No. / 0
//6ate
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjurythat I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, 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 Contractors' 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).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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
)Lof the work for which this permit is issued.
I have and will maintain workers' compensatio nsurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
My workers' compensation i ance carrier and policy number aIII
artier • olic Number—M\(\ I I -tom (� �11 certify a , in the performance of the work for which this permit is isgLWd, I not emp y 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 3700 of the Labor Code, I shall
forthwith comply with those pr isions.
ate plicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
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
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 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 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
construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
ate -0 LSignature (Applicant 0
r
4" .. Application Number 05-00000069
----------------------------------------------------------------------------
Permit . . . . . . 'WALL/FENCE PERMIT
Additional desc
Permit Fee 15.00
Plan Check
Fee
00
Issue Date . . . .
Valuation
. . .
. 352
Qty Unit Charge Per
Extension
BASE FEE
----------'---------------------------
15.00
---------------------------------------
Special Notes .and Comments
2 MONUMENT SIGNS COMPRISING 22 L.F. 4'
BLOCK WALL, ORCO SYSTEM @ ENTRANCES TO
LA QUINTA DEL ORO, TRACT 3'0521
Fee summary Charged Paid
Credited
Due
Permit Fee Total 15.00
.00
.00
15.00
Plan Check Total .00
.00
.00
.00
Grand Total 15.00
.00
..00
15.00
~ r r
' Approved.by; Date . Reso #
U Planning Commission
ity Council. .
community Dev. Dept.,
Initials 'dhyt/` I v5
Case No.
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