05-1030 (BLCK)T4hf 4 4 a"
BUILDING & SAFETY DEPARTMENT
�. BOX 1504 (760).777-7012
•495 CALLS TAMPICO FAX (760) 777-7011
QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
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APN:
Application description
Property Zoning .
Application valuation
BUILDING PERMIT
. . . 05-00001030 Date 3,/23/05
556:5.0 CHERRY HILLS
775-170-024- - -
WALL/FENCE
LOW DENSITY RESIDENTIAL
2295
Owner Contractor
DI LORENZO BROS. INC DI.LORENZO BROS, INC.
P O BOX 1477. P.O. BOX 1477
BANNING CA 92.220 BANNING CA 92.220
(909) 22-0853
WCC: STATE FUND
WC: 739292 03/27/05
CSLB: 498407 09/30/06
CCC: B -C36
Permit . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . '54.00 Plan. Check Fee .00
Issue Date . . . . - Valuation 2295
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG 2,001-21,5,000 9..00
Special Notes and.Comments
106 .LF 5' BLOCK WALL PER.ORCO STANDARD.
Fee summary Charged Paid Credited
Permit Fee Total 54.00 .00 .00
Plan Check Total .00 .00 .00
Grand Total 54.00 00 .00
- Due
54.00
.00
54.00
P.O. Box 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 7774153
BulLDING & SAFETY DEPARTMENT
Application Number: 99 �Z__ f D Date:
Applicant:
L2AL4 4i: Tom ----
Applicant's Mailing Address:
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 lam licensed under provisions of. Chapter .9 (commencing with Section 7000) of'Division 3 of the Business and Professionals
Code. and my Li nse is in full fojjce and effect.
License Class _f : h License No. / v /y�
.Da �C3' —'Contractor'1Jl ll d til- 2d BRO S
OWNER4BUILOER 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 requires a permit to construct,,alter, improve, demolish, or repair any structure, prior to its'issuance, also requires the applicant tot the permit to file a signed
statement that he>orshe 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 h&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 stnicture is not intended or offered for sale (Seo. 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 thatthe 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 ofthe 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 buildsor improves thereon, and who contracts for the:projects with a contractors) licensed pursuant to
the Contractors'State License Law.).
U I am,exemptunder Sec. , B.& P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I'hereby affirm under penalty of perjury one of the following declarations
I'have and.will maintain a certificate of consent to,seff-insure'for workers' compensation, as provided for by Section 3700 of the Labor Code, for the:perfornance
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
,�s5ued. M"oars' compensation insurance varier
Carrier S 1 A(i t c rrl� Policy Number
_ I certify that, in the performance of the work for which this pda t is issued, I shall not employ any person in manner so -as to become subject to the workers'
compensation laws of Califomia, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith complywiththose provisions.
Date �' 2 �� J f.aplicant
WARNING: FAILURE TO SECURE WORKERS''COMPENSATION,COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TOCRIMINAL 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'iName
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety fora permit subject to the conditions and restrictions set forth onthis application.
1. Each person upon whose,behalf this application is made, each person, atwhosw request and for whose benefit work is,perforned!under or pursuantto any.pennit
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.
1 certify that 1 have read this application and state thatthe above information is cored. 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.
Date — 23-6 5 • Signature (Applicant or Agent):