04-4837 (BLCK)P.O. Box 1504
7:8-495 CALLS TAMPIC,O
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
Application Number I
Property Address . .
APN:
Application description .
Property Zoning . . . . .
Application valuation .
BUILDING & SAFETY DEPARTMENT
(760) .777-7012
FAX (760) 777-7011
INSPECTION REQ.UESTS,'(760) 777-7153
04-00.004,837 .
55830 CHERRY HILLS
775-170-021-21
. WALL/FENCE
LOW DENS -I TY' RE
2598
Date 6/09/04
Owner Contractor) CITY OFLApUINTA
----------------------------------------EI�IANCE:I��RT-
JIM CURRIE LEGACY HOMES
54425 AVENIDA MARTINEZ P.O. BOX 696
LA QUINTA CA 922.53 LA QUINTA CA 92253
(760) 777-8317
WCC': KNOX INS.
WC.: 013`30203 0,6/14/04
CSLB 778280 0.5/3.1/06
CCC: B
Permit . . . . . WALL/'FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00' Plan Check Fee .00
Issue Date .. . . . Valuation . . . . 2598
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG 2,001-25,000 9..00
Special Notes and Comments
120 LF 5' BLOCK WALL PER CITY STANDARD
ALONG SOUTH P/L AND GATE AT WEST SIDE.
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
54.00 .,00
.00 .00
54.00 .00
Credited Due
00 54.00
.00 .00
.00 54.00
P.O. BOX 1504• �� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
.LA Q.UINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-715,3
BU.ILDING & SAFETY DEPARTMENT
-Application Number:
Applicant:
Applicant's Mailing Address:
Date: 9 - S- O
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED -CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that am,licensed.under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License i full forceland effect. 7� p 2 O
License Class iCenSe No. / O a
�
Date LIA
Contrector 1
OWNER43UILDER DECLARATION
I hereby affirm under penalty of perjury thaLl 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 pernitto construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant-forthe permit to file a signed
statement that he or she is licensed pursuant to the provisions.of the•Contnactors' State License Law (Chapter9 (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 fora permit subjects
the applicant to a civil penalty of not more than five hundred dollars,($500).):
U 1, as owner of the property, or rnyemployees 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 ari owner of property who builds or Improves thereon, and who does the work
himself or herself orthrough his or her own employees, provided that the improvements are notintended 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 affirnwnderpenalty of perjury one of the following.declarations:
I have and will maintain a certificate of consent to self -insure forrworkers' compensabon,.aspmvided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
1 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
vissLued. My workers' compensation insurance carrier
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 Bre workers'
compensation laws of California, and agree that, If l should become subjecLto the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions. i
Date Applicant
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), KADDITION 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 nstruction lending agency for the performance of the work'for which this permit is issued (Sec. 3097, CN. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Applicationis hereby made to the Director of Building and Safetyfor.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 IB 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�oromission 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.
1 certify that I have read this application and state thatthe abovejnformadon 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 to nt upon the tioned property for inspection purposes.
Da Signature (Applicant or ge