05-0408 (BLCK)1504
LLE TAMPICO
k, CALIFORNIA 92253
BUILDING PERMIT
Application description . .
Property Zoning . . . . . . .
Application valuation . . . .
Owner
STAMKO DEV CO
C/O PROVIDENT FINANCIAL MGMT
10345 W OLYMPIC BLVD 2 FL
LOS ANGELES CA 90064
BUILDING & SAFETY DEPARTMENT.
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
(05DO 000-0.4-08 Date 2/04/05
79305 HIGHWAY 111
649-030-999-7 -30420 -
WALL/FENCE
REGIONAL COMMERCIAL
850
Contractor
CONSTRUCTION DESIGN SYSTEMS, I
78401 HIGHWAY 111, SUITE F-2
LA QUINTA CA 92253
(760) 771-3593
WCC: STATE FUND
WC: 1709785-2005 02/01/06
CSLB: 767086 08/31/05
CCC: A -B
----------------------------------------------------------------------------
Permit . . . . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 23.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 850
Qty Unit Charge Per Extension
BASE FEE 15.00
4.00 2.0000 HND BLDG 501-2,000 8.00.
-----------------------------------------------------------------------------
Special Notes and Comments
34 if 6' block wall(city standard) for
trash enclosure per approved precise
grading plan,.confirmed verbally per
Fred Baker of CDD
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
---------- ----------
23.00 .00
.00 .00
23.00 .00
W
Credited Due
---------- ----------
.00 23-.00
.00 .00
.00 23.00
P.O. BOX 1504 • 'G�
.VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 67,j-" bVcb — I Date: 2--Y O�S_
Applicant: 6
Applicant's Mailing Address:
BUILDING PE�111N.1
LICENSED CONTRACT
I hereby affirm under penalty of perju that I am Ili sed under provisions of Chapter 9
Code, and my License is ip full force d effect.
License Class - v License No.
�DateG-�� 66 1Contracto
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
DECLARATIONS
DECLARATION
rencing with Section 7000) of Division 3 of the Business and Professionals
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I a empt 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 construc Iter, 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 provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exam 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 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 or 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.).
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 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 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' compe io nsura ce, as required by Section 3�theorCode, for the performance of the work for which this permit is
ids ued. My workers' compensati msu nce card r and policy number are,
Carrier !J7 +ir� F Poli Number ��
I certify that, int the performance f the ark for whi this permit is issued, I shall not employ any p on in any manner so as to become subject to the workers'
compensation laws of Califo ia, d agree th, if I sho the workers' compe s 3 ion provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those p A ions.
Date � Applicant �
WARNING: FAILURE TO SECURE WORKERS' M ENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND LLARS
S($1 90)
ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTERES , AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that the 's a construction lending 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 a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, eac nd for whose benefit work is performed under or pursuant to any permit
issued as a result of this application, the owner, an applicant, each agrees to, and shall, d, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or fission related the work being performed under o allowing issuance of this permit.
2. Any permit issued as a result of this appli ion becomes n and void if work is not commenced withi 180 days from date of issuance of such permit, or
cessation of work for 180 days will sub' ct permit to can
I certify that I have read this application and state hat the ab ation is correct. I agree to mply ' all city and county ordinances and state laws relating to building
construction, and hereby authorize representativ of IN ou enter upon the above-mentio operty for inspection purposes.
! Date v' �� Sgnature (Applican or A nt):
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