07-2166 (BLCK)t
� O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
0-f- 0-0002166 �
57600 ROSEWOOD CT
762-240-011-27 -32279
WALL/FENCE
LOW DENSITY RESIDENTIAL
4500
Architect or Engineer:
NA.
4 -
BUILDING.& SAFETY DEPARTMENT.
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
STANDARD PACIFIC COACHELLA
VLY
15326 ALTON PKWY
I hereby affirm under penalty of perjury one of the following declarations:
` IRVINE, CA 92618
(949)789-1600
Licenqp C ss: • ense Np.: 641665
n
J
Contractor:
STANDARD PACIFIC CORP
"15ate:
1717 E VISTA CHINO A7 PMB
#30
PALM SPRINGS, CA 92262
(760)669-6200
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Lic. No.: 641665
Carrier SEA BRIGHT INS Policy Number BB1070237
Date: 7/24/07.
LI f
• if
U
CITY OF LA QIUINTA
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION -
WORKER'S COMPENSATION DECLARATION
'I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Licenqp C ss: • ense Np.: 641665
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�l1issued.
U ontractor: VFgJ
I have and will maintain workers' compensation insurance, as required by Section 3.700 of the Labor
"15ate:
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: .
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier SEA BRIGHT INS Policy Number BB1070237
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter,improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so come su ject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
- and agree that, if I she d becom subje to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or
3700 of the Labor C de, I shall kt ' In those provisions.
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).:
late: V plicant:
1 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 sate (Sec. 7044, Business and Professions Code: The
WARNING :.F (LURE TO SECURE WORKERS' COM 6-S 117toVIRAGEISUNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND `
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for. sale. If, however, the building orimprovement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
- APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.'
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. -
_. propertywho builds -or improves thereon, -and who contracts for theprojectswith a contractor(s) licensed
1: Each person upon whose behalf this application is made, each person at whose request and for
pursuant, to the "Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
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. "
I certify that I have read this application and state that a information is correct. I agree to comply with all
city and county ordinances and state laws relating t wilding con ructio reby authorize representatives
of this my to ,'rnttferr upon the above-mentioned operty fo ' s ction Yrpo S.
ate: v 75i cure (Applicant or Agent
ry
..
Application Number . . . . .. 0.7-00002166"
Permit WALL/FENCE PERMI"T
Additional•desc .
Permit Fee .. . 72.00
Plan Check
Fee
.00
Issue Date
Valuation
4500
•
Expiration Date'... 1/26/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 •9.0000 THOU BLDG 2,001-25,000"
27.00
--------------------------------------------------------------
Special Notes and Comments
180 L.F.. 6' GARDEN WALL, PROTO SYSTEM
Fee summary Charged Paid
Credited
Due
Permit Fee Total 72.00
.00
00'
72.00
-.-Plan Check Total .00
.00
.00
.00
Grand Total 72.00
.00
.00
72.00 _
LQPERMIT
-
'