04-3719 (TT)-I
a
amrajBUILDING & SAFETY DEPARTMENT
c o�� :P.O. BOX 1504 (760) 777-7012
Of I1' 78-495 'CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-7153
BUILDING PERMIT
Application Number
04-00003.719 Date 4/27/04
Property Address
78360 -HIGHWAY 111
APN:
604-050-047- - -
Application description'.
.TEMPORARY TRAILER
Property Zoning..
COMMUNITY COMMERCIAL
Application valuation..
1100
Owner::'
Contractor
- - - - - - - - - - - - - - - - - 1}
- - 1 - - - - - - - - - - -- - - -
- - - - -
SHOVLIW1M`ICHAEL J
7".
PRIMUS''CONTRAdTING
GROUP, INC
71084 TAMARISK.LN.-
-SO,--60.0. .,WEST.,...
SUITE D
RANCHO :MIRAGE CA,. 92270
BOUNTIFUL :'.• :. : °
UT 84010
WCC.: STATE FUND:
-
WC: 17051812003`
10/01/04
. .. .._ ...;';.
CSLB f ..- 854`72`6'- `-:._ ,
.- , - . 11/30/04
CCC: B
Permit TEMP TRAILER / MOBILE HOME
Additional deac
Permit Fee . . . . 200.00
Plan Check Fee
.00
Issue Date
Valuation
1100
Qty Unit Charge Per
Extension
BASE, PEE
--------------
200.0.0
----------------------
Special-'Notes and Comments
--------------------------
--------------
TEMPORARY. TRAILER PER TUP 2.0-04-:4.5
Fee summary Charged
Paid ".._.Credited'.
Due
Permit Fee Total' 200.00.
:00 .00
7200.00
Plan 'Check Total . 00
.00. ..00
00
Grand Total., -_200:00-:
-0.0 .: „ 00..'; <, '
200'.''0 0
P.O. BOX 1504 ��
79-495 CALLE TAMPICo VOICE (760) 777.7012
LA QUINTA. CALIFORNIA 92253 FAX (760) 777.7011
44a
INSPECTIONS (760) 777.7153
BUILDING & SAFETY DEPARTMENT
Application Number. O t -3 715 Date:
Applicant:
/ CQD
Applicant's Mailing Address:
Architect
Aor�E✓
Y vy
ArChitect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
1 herreby atbrm under LICENSED CONTRACT04M DECLARATION
° ' °f p�'''M l am licensed" JR . pier of poplin 9 (aonmendnp vft Section 7000) a Division 3 d the Business and Pwk:sionals
Code. and my LJoW Is In fu11 tufo and dfo&
Lioense Close No. 91 f 7 L 6
411ri�e
I hereby aft. under penalty Of pWJWY riot 1 am $UL.DER DECLARATION
Peolessior C04 Any
kye , Ounty me ite � ioana.d apan b ' �a� do noW « pdWb State Lkw" Law for VIC ft$DwkV mom �.s Arid Ill , fw usiness t» p b w8 & sowd
qw
and Prdassiors Code) or rid he or side k � b pl d#0 Contractors' State Lbanoe law (Chaplin 9 (ip with Secson 7000) a Division 3 a the Business
the appiarri b a CM excerpt riaehnm and the basic lir ria akeged exemption. Any violation a Section 7031.5 by any applicant lir a permit sub j M
U 1, as owner d the property, � tM tie hundred � ��� WE 60 ria work and the Structure Is not Herded or ofm for ab (Sac 7044,
Business and Profesdorrc Code: The Corlbactors' stab License Law does not apply b an owner d property who bunds or improves thereon, and wto does the work
hirnselforhersell sand within one or trough his or her own employees, provided rid the improvements are not intended or offered for sak.
It however. the OrAdrrrg a inprowernent is
U t as WNW d c 104 d � 4 the owner-0rr%W wi have the burden d proving rid he or she did not build or irpmn for the purpose dk ).
sa
Stale LicenseLaw does #0
e��y cm*actkq with kensed contractors b construct go go project (Sec 7044. Business and Professions Code: The Contractors'
ft ConbacbW State lioerrse—law.) Io an owner d property who builds or irproves riereor� and who Contracts lir the projects witha oonbactor(s) tioensed punwsnt b
U 1 am exempt under sec. _ B.& P.C. for this recon
Date Owner
I hereby affirm undopenalty d perjury one a the bowing declarations: WORKERS't:01APENSIITtON DECLARATION
_ 1 have and wit maintain a ovokate of consent b self4nan lir workers' compensation. as presided lir by Section 3700 d the Labor Godo. lir the pMomrrerroe
d the work lir wtidr this pen. is ksued
— l vA maintain workers' compensation insurance, ss required by Section 3700 of the Labor Code. for the pertorrrm" at Be work lir whia, this per.. Is
Confer S T/► ,>)� �°e anier and pok number aro
1 POW Number�'70Sid I umber
oetkty ihd, in Cue perlormarxy d the work lir whkh His pent is issued. l &W rel employ any person in any roamer to as to beoona oubject b the workers•
conlim' rm lours err Cafifomia, and aproe rid. r I should become subject b the
bftft comply wM those workers' OOnVGn&VJM provisions of Section 3700 of the Labor Code. l shall
oa1e [ 27 (% APPS
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION C GE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRNMNAL PENALTIES AND
CML FINES UP TO ONE HUNDRED THOUS ND DOLLARS ($100,000) IN ADOmON TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE. MEREST. AND ATTORNEY -S FEES. .
1 hereby affirm underpenally d cry rid ries k a eonsbr+c4orr CONSTRUCTION LENDING AGENCY
V agency lit the PeAamwm of the work for which this peril is issued (Sec. 3097. Ck. C.).
Lenders Name
Lenders Address
IMPORTANT Application is hereby rrgde b the Direcbr aAPPLCANT ACKNOWLEDGEMENT
1. Each penton upon whose Oehalf Cas BuG tp b th
and Safety lir a Permit subject e conditions and restrictions set loft on Cis application.
application is made. each Person at wise request and lir whose benefd work is
Issued as a resuk d this appicdion, the owner. and the applicant each D under a pursuant b any peril
oK and employees lir any act or omission related b the work b. errd ct►ak, defend, Mdemnify and hold lwwn " the City d LoGuInIc its
Z Any Pwff issue c lir 9 result f this
h a�� becomes null and void k words not commenopedormed �ed witittinn 160 fohowing Issuance a Cis issuance
pm. or
Y= pen, b cencekation, deys from dated issusnx a such
1 Cef* that I have read this appiabon and state that the above kdom>ation is 00,11 1 some b comply with all cit and
Construction. and hereby authorize representatives a this b enter above�rrerr property lir inspection county noes and state lo we relating to iwYdirq
Date Signature (Applicant or Agent