05-0180 (BLCK)T&f 4 4 494
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153.
BUILDING PERMIT
Application Number . . . . . 05-00000180 Date
Property Address . . . . . 78625 BOTTLE BRUSH DR
APN: 646-312-012-62 -000000-
Application description . . . WALL/FENCE
Property Zoning MEDIUM DENSITY RES
Application valuation 6083
Owner
POWER FINANCE
P.O. BOX 134
LA QUINTA CA 92253
1/19/05
Contractor
--------------=--------=
CONTEMPORARY HOMES INCORP
P.O. BOX 1141
LA QUINTA CA 92253
WCC: STATE FUND
WC: 16764082004 07/01/05-
CSLB: 736920 - 03/31/05
CCC: B
---------------------------- -----------------------------------------------
Permit . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 90.00 Plan Check Fee .00
Issue Date . . Valuation . . . . 6083
Qty Unit Charge Per Extension
BASE FEE 45.00
5.00 9.0000 THOU BLDG 2,001-25,000 45.00
-------------------------------"---------------------------------------------
Special Notes and Comments
200 L.F. 6' BLOCK WALL, 50 L.F. 5'
COURTYARD WALL, BOTH CITY STANDARD
Fee summary Charged Paid Credited Due
-------------------------------------------------------
Permit Fee Total 90.00 .00 .00 90.00
Plan Check Total .00 ..00 .00 .00
Grand Total 90.00 .00 .00 90.00
p LQ Q
K' .� •SAN 2 4 2005
CITY OF LA QUINTA
FINANCE DEP'
P.O. Box 1504 • VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 50 Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
A
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm undef—pe-n-qfry of perjury that I am licensed under provisions of Cha ter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Lice n is' full force and effect. �3 2
�nse Class �Cicense No.
L tractor `4, ISPs tf—L•0
OWNER -BUILDER DECLARATION
I hereby affi under penalty of perjury that I am exempt 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 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 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 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).):
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.
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
r".rs' compensation in5primce carver gnc 4o py rlurQ 5are�.�
�er icv Number / 6 G / J
I certify that, in the performance df the work for which this permit is issued, I shall not employ an person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwi comply—with those provisions.
Dat Applicant��� `
ARNI FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
IVIL F ES 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.
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 a
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the c
1. Each person upon whose behalf this application is made, each person at whose requ c
issued as a result of this application, the owner, and the applicant, each agree and shall,
officers, agents and employees for any act or omission related to the w eing performe nc
2. Any permit issued as a result of this application becomes null and if work is not c men
cessation of w for 180 days will subject permit to cancella
I certify that I have rea is appli�n and state that the above inf ation is correct. 1 o comply N
constctio and h y aut iC
representatives of this count enter upon the above-mentioned propt
at Signature (Applicant or Agent):
and restrictions set forth on this application.
benefit work is performed under or pursuant to any permit
iem and hold harmless the City of La Ouinta, its
win ssuance of this permit.
jj4day. from date of issuance of such permit. or�—
%II city and county ordinan state laws relating to building
for inspection pujrxieeg—