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05-0080 (BLCK)BUILDING & SAFETY DEPARTMENT I' "if � Ig"49°5 CeAiLE TAMPICO (760).777-7012 ��III� FAX (760) 777-7011 I� LA QUINJA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 U JAN 18 2005 U CITY 07: LAQUINTA BUILDING PERMIT FICM� DEPT. Application Number . . . . . �Q5=00-0-0-0-08-0� Date 1/07/05 Property Address . . . . . . 80385 CAMARILLO WY APN: 772-250-997-121 -31349 - Application description . . . WALL/FENCE Property Zoning . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 1800._ Owner Contractor, ------- ------------------------ ------------ -------------------- TOLL CA V TOLL BROS, INC. C/O KEVIN D DUERMIT 73121 FRED WARING DRIVE, #100 8901 E MOUNTAIN VIEW 200 PALM DESERT, CA 92260 SCOTTSDALE, AZ 85258 - (760)674-9699 WCC: MARSH USA INC. WC: WA762DO04723014 09/01/05 CSLB: 777699 04/30/06 CCC: B ---------------------------------------------------------------------------- '1 P.O. Box 1504 TAot!t/I / VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: (' `J—�S� Date: Applicant: Applicant's Mailing Address: Architect or Engineer, Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division.3 of the Business and Professionals Code, and my Licen s in full force and effect. �►}� // [�, cense Class ;cense No. L ! l f0 7 OWNER -BUILDER DECLARATION I hereby affirm 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. 11 -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 1 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. 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 rns ce caner and policy number are: arrner MAAASP 3if icy Number �t//l 727 0 06 q i 2%401 _ I certify that, in the performancefowork for which this permit is issued, I shall not employ any 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, 1 shall forthwith comply with those provisions. Date_ /' A� 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 ($100,0001, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 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 6— 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. 1 certify that I have read this application and state that the above infornation is correct 1 agree. to comply with all city and county ordinances and state laws relating to building ;consUluction,nd hereby authorize re ntatives of this county to enter upon the above-mentioned property for inspection purposes. e �T Signature (Applicant or Agent): _�/¢� ---------------------------------------------------------------------------- ' Application Number . . . . . 05-00000080 Permit . . . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 41.00 Plan Check Fee .00 Issue Date. Valuation . . . . 1800 Qty Unit Charge Per Extension BASE FEE 15.00 13.00 2.0000 HND BLDG 501-2,000 26.00 ---------------------------------------------------------------------------- Special Notes and Comments 72 L.F. 6' BLOCK WALL, ORCO SYSTEM Fee summary Charged Paid Credited Due Permit Fee Total 41.00 .00 .00 41.00 Plan Check Total .00 .00 .00 .00 Grand Total 41.00 .00 .00 41.00