05-2904 (BLCK)a
4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011.
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/12/05
Application Number: A05-00002904��,___ Owner:
Property Address: ; 52790. AVEN— I� Rr..!h IREZr MOSMITH DEVELOPMENT
APN: x-773 323=002-25 -000000- 51300 AVENIDA DIAZ-
Application description: WALL/FENCE D 6 LA QUINTA, CA 92253
Property Zoning: -- _ COVE RESIDENTIAL
Application valuation: 2250
JUL 13 2005 Contractor:
Applicant: Architect or Engineer BARRILE CONSTRUCTION
cru -®.F. P O BOX 1155
• •` EEpr LA QUINTA, CA 92247
(760)771-2984
tic. No.: 378318
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I m licensed under provisions of Chapter 9 (commencing with
Section 700 of Division 3 of the Business n Professionals Co e, and my License is in ful force and effect.
Li a CI srunder
B Li a No.: 378318r
Date: antractor.:_
OWNER -BUILDER DECLARATION '
I hereby'affalty of perjurythat 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,. 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 contractorls) 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
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.
_ 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 is issued. My workers' compensation
insurance carrier and policy number are:
Carrier EXEMPT Policy Number EXEMPT
I certify that, in the performanc f the work for which this permit is issued, I shall not employ any
person in any manner so to come subject to the workers' compensation laws of California,
and agree that, if I shout be co a su 'ect to orkers' compensatio provisions of Section
700 of the Labor Code shal forth ith m with those provisio
Date: 7 " Appli t:.. .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL '
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). 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. 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 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 suc arm , or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t a ve i for tion is c ct. I agree to comply with all
city an county ordinances and state laws relating to bu di con tructr n, an eby authorize representatives
of this,kour)ey to enter upon the above-mentioned grope for i pection r o s.
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Application Number ._. . . . 05700002904
Permit WALL/FENCE PERMIT
- Additional desc
}
` Permit Fee 54.00
Plan Check
Fee
.00
Issue Date'
Valuation
. .
. . 2250
Expiration Date 1/08/06
' . Qty Unit Charge Per
Extension J
- BASE FEE
45..00
1.00-- - =-- _-9.0000 TIIOU DLDC 2,001
25,000,
9.00 '
Special Notes and Comments
-------------
90 LF COMBO 18" RETAINING.WITH 6'
GARDEN WALL @ REAR P/LIPER CITY
' STANDARD.
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
s
LQPERMIT -