05-5202 (BLCK)P.O. BOX 1504 x f
78-495 CALLE TAMPICO''�
Lri.•:• 'in:Ja
LA QUINTA; CALIFORNIA 92253 'i. cr`BUIILDING'&- SAFETY DEPARTMENT
VOICE (760) 777—.7012
FAX (760) 777-7011
ue t INSPECTIONS (760) 777-7153
V41;j Lo
- a }° BUILDING PERMIT
Application Number: 11%:i00-0:0-52,'02 tt ®f �nE� A Owner:
Property Address: 5429' `AVENIDA IR, ��� ` GARRY LEATH
APN: 774-243-014-3 -0000010- 54295 AVENIDA RAMIREZ
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL ---------------------------------
Application valuation: 1851 ,
.. ,,..,,,,.. .«. ,�. _ COntfBctorl
Applicant: Architect or Engineer: Owner;,:
---------------------------------
Vy
LICENSED CONTRACTOR'SDECLARATION
I hereby affirm under penalty, of, perjury that 1 am licensed under provisionsof-Chapter 9 (commencing'with '
Section 7000) of Division of the Business and Professionals Code, and my License is in full force and effect.
License Class: _ Liceni 1\16.:
Date: Contractor:
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:Businessland Professions -Code: Any city or county that requires alpermit to
construct,. alter, improve, demolish, or repair any structure, prior to its issuance, also requires .the applicant for the
permit tofile 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 sheds exempt therefrom-and,thebasis 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).:
r. (•� 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 oroffered 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 em ployees,'provided that the -
Ir improvements are not intended or offered for sale. If, however, the building orimprovement is sold within
one year'of completion, the owner -builder will have theburdenof 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 ownerof
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. . for this reason .
t
Dates. -Owner.
> _
CONSTRUCTION LENDING AGEN
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'sAddress:
LQPERM[T
Date: 11/28/05
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.'
1 have and will maintain, workers' compensation,insurance;.as required by Section 370b of the tabor
'Code, for theperformance of the work for which this Permit is issued:. My workers' compensation
insurance carrier and policy number,are;
Carrier .Policy Number
I.certify that, in the performance of the work for which•.thispermit is issued, I shall not employ any
,person in any, manner so o becomesubject to the workers' compensation laws of.California,
and agree that, if I should a ome subject to the workers' compensation provisions.of Section
'Jt\ 370 the Labor Cod ' alrforthw,'ty f�,�,Sr�p�w" i�h those provisions.
WARNING:- FAILURE TO stdb E`WORKERS' COMPE�JSATION COVE E IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO.CRIMINAL-PENALTIES AND CIVIL FINE UP TO.ONE HUNDRED THOUSAND -
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSA ION, 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 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.
Icertify that I have read this application and state that the ve information incorrect. I agree to comply with all
city and county ordinances and state laws relating to buildi nstruction and hereby authorize representatives
of this county to enter upon the above-mentioned prope f nspection purpo -
LQPERMIT
Application Number . . . . 05-00005202
PermitWALL/FENCE PERMIT
'
Additional desc .
Permit Fee . . . . 43.00 Plan Check Fee
00
Issue Date . . . . Valuation
1851
Expiration Date 5/27/06„-..
Qty Unit Charge Per
Extension
BASE FEE
15.00
'
14.00 2.0000 HND BLDG 501•-2,000
28.00
_----------------
----- -_------------------------------------------------------
Special,Notes and Comments
37 LF'5 -BLOCK,WALL IN FRONT WITH_ 4.2,,.LF..,.
P/L . CITY. STANDARD
Fee summary Charged Paid Credited
Due
Permit Fee. Total 43 J00 0.0 00
43.00
Plan Check .Total.. .00. :00 00
00
„
Grand Total 43.00 .00 ..00
43_00
-
i
LQPERMIT