04-3590 (BLCK)BUILDING& SAFETY DEPARTMENT
P.O. BOX 1504 (760) 77717012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-7153
BUILDING PERMIT
Application Number . . .
04-00003590 Date
4/20/04
Property Address
54325 AVENIDA CARR ANZA�
APN:
774-242-015-5 -000-0-0-
0
Application description'.
WALL/FENCE
Pi'operty.Zoning . . . . . .
•COVE RESIDENTIAL
Application valuation
5637
Owner
Contractor
PACIFIC HOMES IN CALIFORNIA
PACIFIC HOMES
P.O. BOX 1023
P.O. BOX 1023
LA QUINTA CA 92253
LA QUINTA
CA 92253
(760) . 408=349.5
WCC: STATE FUND
WC: 1576557
08/0..1/04,.,
CSLB: 782324
08/31/04
CCC: B
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee 81.00 Plan Check Fee
•.00
Issue Date
Valuation
5637
Qty Unit.Charge Per
Extension
BASE FEE
45.00
4.00 . 9.0000 THOU BLDG 2,001-25,000
36.00
---------------------------------------
Special Notes and Comments -
omments250
------------------------.--------------
2.5 0L.F.-5BLOCK WALL, 14 L.F. 4' BLOCK
WALL, BOTH CITY STANDARD
Fee summary Charged
Paid Credited
Due
Permit .Fee. Total 81.00
.00 .00
81..00
Plan Check Total .00
.00 .00
.00
Grand Total 81.00.
.00. .00
81.00
(P.O.BOX 1504 VOICE (760) 777-7012
QAroj,
78-195 CALLE TAMIICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. U 9..4-170 Date:
Applicant: '%I Architect or Engineer.
Appl'icant's Mailing
Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirn under penalty of perjury that I am icensed under provisions of Chapter 9 (comonmenang wtth Section 7000) of Division 3 of the Business and Pwfessionels
and my License is in AA force and effect C"— 0anse / No.4z.
ContractorOWNER$ULDER DECLARATION
I hereby aft.. under penally of perjury that 1 am axmmpt from to Contractors' stab License Law for the k4owig reason (Sec. 7031.5. Business and Professions Code: Any
city or county that requires a penult to construct oiler, improve. denvoish, or repair any structure, prior to Its is vreroe. also requires the applicant for the permit to fie a signed
'statement that he or she Is licensed pursuant to the provisions of the CahtracbW Stab License Law (Chapter 9 (commencing with Section 7000) of Division 3 of to Business
and Professions Code) or that he arate Is exempt tm mefrom and Mme basis ter to alleged exerrptiam Any violation of Section 7031.5 by any appieard fora penia subjects
the applicant b a dvi penally of not more than Tire hundred dollars (i500).):
U 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 ContradorV Stab License Low does not apply to an owns of property who builds or improves thereon. and who does the work
himmsetf or herself or trough his or her own employees, provided that the improvements are not Intended or offered for sale. K, howem the building or improver ent is
sold within one year of completion, the owrer4xalder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U 1, as owner of to property. am GwAnively eordraWng with licensed contractors to construct the project (sec. 711.4. Business and Professions Code: The Contractors'
State License Law does not apply ban owner of properly who builds or improves theieon, and who contracts for" projects with a contraetor(O fioensed pursuant to
the Contractors' State License Law.).
U 1 am exempt under Sea . BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of wrsent to sefl-Insurefor workers• conpensatim as provided for by section 3700 of the Labor Code. for the peAommanoe
of the work for which this permit Is Issued.
I have and will maintain workers' compensation insurance. as requiredbySection 3700 a the Labor Code. for the performance of the work for which Nis permit Is
�iswedM''v+orkegs_`°rrhpe"satiorfty°ODNur,`)i`fo s S—T `•re:
e` _ I cert fy that in th A) 1-1.21
ofthe work for which this permit is issued. l shall not employ any person In any manner so as to become subject b Mme workers'
compensation taws of California, and spree that, ff I should become subject b the workers' compensation provisions of Section 3700 of the Labor Code. l shall
Iortmwith.compiy with torose provisiors.
WARNING: ' FAILURE TO SECURE WORKERS co PENSATION COVERAGE Is IJNLAWFU— AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE }iUNDRED TWOUSANC DOUARS ($700.000). IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3705 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
1 hereby affirm miler penally of perjury that fere is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ. C.).
Lenders Name
Lendees Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application Is hereby made to the Director of Buftng 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 tris application. the owner. and the appicaM, each agrees to, and shad. defend. indemnify and hold harmless the City of Le Omnia, its
officers. agents and anpbyees for any act or omission related to the work being performed under or following issuance of this perfit. .
2. Any permit issued as a nesurtt of this application becomes nup and void it work is not commenced within 160 days from date of issuance of such permit or
cessation of work for 160 days wit subject permit to cancellation.
I certify that I have read this application and state that tha above information is correct I. agree to comply with all city and county ordinances and state laws relating to building
corstructiam, and hereby authorize representatives of this county to enter upon the above-mentioned property for Inspection purposes.
'bate ignature (AppligM or Agent):