07-2163 (BLCK)0
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
0-7_-000 2 63�"
57690 ROSEWOOD CT
762-240-011-24 -32279 -
WALL/FENCE .
LOW DENSITY RESIDENTIAL
4500
Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B Acense No.: 641665(
te: ontracto, f✓ eJ
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 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 _ 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 projocts with a controctorls) licensed
pursuant to the Contractors' State License Law.).
(_ I I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY '
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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
STANDARD PACIFIC COACHELLA VLY'
15326 ALTON PKWY _
IRVINE, CA 92618
(949)789-1600
Date: 7/24/07
Contractor:
STANDARD PACIFIC CO
1717E VISTA CHINO iA.9 MBt3`0`3 g. U
PALM SPRINGS, CA 92 2 2 ` 91t7
(.760)669-6200. �IYVI'.B�QlDB@a�iA d
Lic. No.: 641665r -
WORKER'S 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,
AI 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 issued. My workers' compensation
insurance carrier and policy number are:
Carrier SEA BRIGHT INS Policy Number BB1070237
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any mann so to become subject to he workers' compensation laws of California,
and agree that, if I hould b ome s je orkers' compensation provisions of Section
700 of the Labo h I wit c y wit those provisions.
/Q11: D tOSE
nt:
WAR
NIN F ILU ER URE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). IN ADDITION TO THE COST.OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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. Eeuh peisun 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 Ouinta, 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 s e abo information is correct. I agree to comply with all
city and county ordinances and state laws re in 't uildin c he eby authorize representatives
of this cou tyyt
v enter upon the above-mentioned rrtt ctlo
;ap.-' ature (Applicant or Age I: '
Application Number 07-00002163
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee 72.00 1 Plan Check
Fee
.00
Issue Date. Valuation
4500
Expiration Date 1/20/08
"
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9..0000 THOU BLDG 2,001-25,000
27.00
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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