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04-3539 (BLCK)o Z001� r .• �1�%�Url(% OP BUILDING &.SAFETY DEPARTMENT Pf B! 1504 (7.60) 777-7012 OFT' 8=495 CALLS TAMPICO FAX (760) 777-7011 LA .QVINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-7153 BUILDING PERMIT Application Number . . . . 04-00003.539 Date 4/16/04 Property Address 80345 CEDAR CREST. APN: 762-060-006-6 -28410 - Application description'. . . WALL/FENCE Property Zoning ... LOW DENSITY RESIDENTIAL Application valuation 325 Owner Contractor M/M GIOIA CALIFORNIA POOLS & SPAS 80345 CEDAR CREST. P:O. BOX 1280' LA QUINTA ,COACHELLA CA 92236 L-QUINTA CA 922.5.3 (760 .398-9222 WCC:..: STATE FUND: WC: 04600061168 01/01/05 CS � LB; 656.1.28.. 10 1%04 /3 CCC: C8-C27:=C29-053 Permit WALL/FENCE PERMIT -Additional desc Permit Fee, 15.00 Plan Check Fee .00 Issue Date Valuation . . . . 325 Expiration Date 12/16/04 Qty Unit Charge Per 'Extension BASE FEE ... 15.00 .Special Notes and. Comments' 15 tF '5' BLOCK WALL PER CITY STND. 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 P.O. Box 1504 • l�r�� 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: �3 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Uc. No. BUILDING PERMIT DECLARATIONS . LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio" 700.0) of Division 3 or the Business and Professionals aLicense u License in form and effect, License No. 141�(! Le . Data -�v Cormactor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 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 inquires a permit to construct, after. Improve, demolish, or repair any structure, pricy to Its issuance. also requires the applicant for the permit bide a signed statement that the or she is %erred pursuartt to the provisions of the Cortt ractore State Lioerse 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 (6500).): 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 Contractors' State License Law does not apply io an owner of property who builds or improves thereon, and who does the work hir self or herself or through his or her own erployees. provided that the improvements are not Intended or offered for -sale. If. however. the W&kq or improvement is sold within one year of completion, the owner -bunter wig have the burden of proving dud 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 appy 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. . 64 P.C. for this reason Date. Owmher WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: _ I have and w81 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. _ I have and will maintain workers' compensation insurance. as required by Sedan 3700 of the Labor Code, for the performance of the worts for which this permit is Carrier gar. �'°�„p�'sabop alta p��a"°% �/G g olicy Number_ 1 certiy that, In the performance of the work for which this permit is issued, l shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, If 1 should become subject Io the workers' compensation provisions of Section 3700 of the Labor Code. l shiatl %f�oAthwith.conply with those Zz je,�A Date/ �� APtant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE S 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 ATTORNEYS FEES. . CONSTRUCTION LENDING AGENCY l 1 hereby affirm under penalty of perjury that there is a constructionending agency for the performance of the work for which this permit is issued (Sec. 3097. Civ. C.). Lenders Name Lenders Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application Is hereby made to the Director of Building and Safety for apermit 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 pem* Issued as a result of this application. the owner, and the applicant, each agrees to, and shalt, defend. indemnify and hold harmless the City of Le Ouir". its officers, agents and employees for any act or omission related to the work being pertomned under or following issuance of this permit 2 Any permit Issued as a result of this application becomes nutl 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. 1 certify that I have read this application and state that the above info is correct, I agree to comply with all city and county ordinances and state laws relating to building construction. �`` anreby d heautMrize representatives of this county to a er above- mentiorned property for Inspection purposes. Date _ -5' ' /J Signature (Applicant or Agent):