06-0559 (BLCK)woe
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 06-00000559
Property Address: 79275 HIGHWAY 111
APN: 649-030-999-10 -30420
Application description: WALL/FENCE
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 2560
T4&t 4 4 Q"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
M/M D.MANISTA/M/M T. OLSEN
1242 N KENNYMEAD
ORANGE, CA 92869
kCITYContractor:
MORRISSEY CONSTRUCTION CO INC
4083 OCEANSIDE BLVD, STE G
a�oOOCEANSIDE, CA 92056
FEB V, O (760)639-0498QUANTA Lic. No.: 708936
QP- lF� .,Co -r
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/08/06
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L�iCENSED CONTRACTOR'S ECLARATION I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perj that m licensed under provisio of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the
License Class: A -B -C8
Date: ?,-016 i Contractor:
Code, and
tense No.:
y License is in full force and effect.
OWNER -BUILDER NIN ON
I hereby affirm under penalty of perjury that I am exempt from thector'sStateLicense Law for the
following reason ISec. 7031.5, Business and Professions Code: Aor county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License 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 ($500).:
(_ 1 I, 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 to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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.).
(_ 1 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.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
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 Name: _
Lender's Address:
LQPERMIT
I have and will 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 Section 3700 of the Labor
Code, for the performance of the work for which this permit :issued. My workers' compensation
insurance ca 'er and policy number are:
Carrier STATE FUND Policy Number 4670007
1 certify that, in t e erfor nce of the work f which this permit i 'ssued, I shall not employ any
person in any n er so to become subje t o the workers' co ensation laws of California,
and agree that, if ould come subject to workers' compen ion provisions of Section
9 I
3700 of the Labor de. 1 s 1 forthwith com v with those Drovis s.
r
Date:Zq'V V Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CO ER GE WFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINEU TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATI DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FE
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building 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 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\atiomes null and void if work is not commenced
within 180 days from date of issuarmit, or cessation of work r 180 days will subject
permit to cancellation.
I certify that I have read [his application and statea information is correct. I ag a [o comply with all
city and county ordinances and state laws relatinstruction, and reby author representatives
of this county to enter upon the above-mentionedn eci npurposDate:�Q. Signature (Applicant or Agen
Application Number . . . . 06-00000559
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 2560
Expiration Date 8/07/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
'?
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Special Notes and Comments
160 LF BLOCK WALL LESS THAN 4' PER CITY
STANDARD &.APPROVED PRECISE GRADING PLAN
Fee summary Charged Paid Credited
Due
-----------------------------------------------
Permit Fee Total 54.00 .00
----------
.00
54.00
Plan Check Total .00 .00
.00
.00
Grand Total 54.00 .00
.00
54.00
rt -
it