06-2924 (BLCK)P.O. BOX 1504
�.'78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
06-00002924
81789 CONTENTO
767-200-011-10 -318742-
WALL/FENCE
LOW DENSITY RESIDENTIAL
3775
T4'yl 4 4 Q"
Architect or Engineer:
D 1A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
TAYLOR WOODROW-HOMES, INC
15 CUSHING
IRVINE, CA 92618
Contractor:
TAYLOR WOODROW HOMES INC
16745 W. BERNARDO DR, ST
SAN DTEGO, CA 92127
(949)341-1200
Lic. No.: 352047
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/07/06
tAUG 3 0 2086 L
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LICENSED CONTRA R'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby ffi,;/.de enalty of perjury that I am licensed un provisions of Chapter 9 (commencing with
1 hereby affirm under penalty of perjury one of the following declarations:
Section 700 of D' ision 3 of the Business and Pro ssion ode, andLicense is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License cense 2047
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date: Contractor:
issued.
I have and will maintain workers' compensation insurance, wired by Section 3700 of the Labor
Code, for the performance of the work for which this p rmi is issued. My workers' compensation
OWNER -BUILD DECLARATION
insurance carrier and policy number are:
I her by affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier LIBERTY MUTUAL Policy Number 76 D283614056
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
thi permit is issued, I shall not employ any
_ I certify that, in the performance of the wor .;to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
pers in any manner so as to become be orkers' compensation laws of California,
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
an gree that, if I should ecome sub' ct vers' comp tion provisions of Section
3 f the Lobar C shall forth ith cith th a Bionsthat
he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 byl./�.d��w
an a licant for a ermit sub'1ects the a Iicant to a civil enalt of not more than five hundred dollars ($500)
.
y pp P — p Y ••
(_) 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 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.).
( 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: PIK
LQPERMIT
WArING:/FAILURE TO SECURE WORKERS' COMPENSATION COVORAIGE 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 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 aZcect.
k is of commenced
within 180 days from date of issuance of such permit, or cess.for 80 days will subject
permit to cancellation.
Mkehis application and state that the above informa ' agreeto comply with all
s and state laws relating to buildin structi , thori r r entatives
n he above-mentonedpropmspecti pu
ature (Applicant or Agent):
Application Number . . . . . 06-00002924
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 63.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 3775
Expiration Date 2/03/07
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU BLDG
2,001-25,000
18.00
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Special Notes and Comments
151 L.F. 6' GARDEN WALL, PROTO II
SYSTEM
Fee summary Charged
- -- --- - - - - - - - - - ------ - - - - ------------
Paid
Credited
----- - - - ---
Due
--- - - - - --
Permit Fee Total 63.00
.00
.00
63.00
.Plan Check Total .00
.00
.00
.00
Grand Total 63.00
.00
.00
63.00
LQPERMIT