06-2923 (BLCK)P.O. BOX 1504
` 78-495 CALLE TAMPICO
. LA QUINTA CALIFORNIA 92253
Application Number. X06=000.02923 J
Property Address: 81773 CONTENTO
APN: 767-200-011-9 -318742-
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: '4200
Applicant:
T44t 4 4 Q"
Architect or Engineer:
D 1
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRA O 'S DECLARATION
I hereby affirm }}fi�nder pe alty of perjury that I am license un r ovisions Chapter 9 (commencing with
Section 70001/of Divi. n 3 of the Busines d Profe ion de, jInLicense is in full force and effect.
License Clas B Li nse 52047
I here* affirrh under penalty of perjury that I am exempt from 4he 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).:
(_) 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, 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.).
( 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:
LQPERAIIT
Owner:
TAYLOR WOODROW HOMES, INC
15 CUSHING
IRVINE, CA 92618
Contractor:
TAYLOR WOODROW HOMES INC
16745 W. BERNARDO DR, STE 140
SAN DIEGO, CA 92127
(949)341-1200
Lic. No.: 352047
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/07/06
D Q 0
AUG 3-0 2006
CITY OF LA QIIINTA
FINANCE DEPT.
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 per is issued. My workers' compensation
insurance carrier and policy number'are:
Carrier LIBE TY MUTUAL Policy Numb fr WA 6 D283614056
1 tify that, in the performance of the work fo which i permit is issued, I shall not employ any
rson in y manner so as to become subj ct to th orkers' compensation laws of California,
nd agr that, if I should ome subject the kers' co pen o provisions of Section
0 jYie Labor Co shall forth�it �o ith thos prS74'
WARMNG: 11L6RE TO SECURE WORKERS' COMPENSATION COVERAGE S 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 Quinta, its officers, agents and employees for any act or omission related tothe ork 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 no o menced
within 180 days from date of issuance of such permit, or cessation of work fnr.1 0 ys will subject
I certify that I hav read is application and state that the above information is co ect. I ree o comply ith all
city and county rdina a and state laws relating to building c uction, and reby a o ' e repr a ves
of this t n the above-mentioned propert inspection p po s.
ate: S re (Applicant or Agent):
LQPERMIT
Application Number . . . . . 06-00002923
Permit
WALL/FENCE PERMIT
Additional desc..
Permit Fee . . .
. 72.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 4200
Expiration Date
2/03/07
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
168 L.F. 6' GARDEN
WALL, PROTO II
SYSTEM
.
Fee summary
-----------------
Charged
--------------------
Paid
Credited
--------------------
Due
-Permit Fee Tc -al
72.00'
.00
.00
72.00
Plan Check Total
.00
.00
.00
.00
Grand Total.
72.00
.00
.00
72.00