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05-3774 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: IL05­00003774 Property Address: 81550`CARBONERAS APN: 764-200-006-27 .-316811- Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3950 Applicant: Ta�p 4.4 Q" Architect or Engineer PIA BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70P01 of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License CI ss: 1B /—bLcense No,/PG$987 Owner: CORAL OPTION I 79295 RANCHO LA QUINTA DR LA QUINTA, CA 92253 D c� 'J p Gr�O� P C tractor: DESERT DEVELOPMENT LP P O BOX 1716 LA QUINTA, CA 92247 (760) 771-1941 Lic. No.: 762987 ' 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, 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 155001: (_ 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 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.). ( _d 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 _ 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: %^ LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/25/05 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. 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 insurance carrier and policy number are: . Carrier STATE FUND Policy Number CA005001482-001 I certify that, in the performance of the work 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, an agree that, if 1 should bec subject to the workers' compensation provisions of Section �OO bor Code, all fort ith comply with those provisions. Da/: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER L11.AWFUL, 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 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 information is correct. I agree to comply with all city and co ty o finances and state laws rely ' building construction, and herauthorize representatives of/this�.,ou jy to Hier upon above -m coned pro erty for in ion urposes. aD te:V '` Signature (Apglt�or Agent) Application Number . . . . . 05-00003774 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 63.00 Plan Check Fee .00 Issue Date Valuation . . . . 3950 Expiration Date 2/21/06 ` Qty Unit Charge Per Extension BASE FEE 45.00 2.00 9.0000 THOU BLDG 2,001-25,000 18.00 ---------------------------------------------------------------------------- Special Notes and Comments 158 L.F. 6 ' GARDEN WALL, 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 INSULATION CERTIFICATE This is to certify that insulation has been installed in conformance with the current energy regulation, California Administrative Code, Title 24, State of California, in the building at 89.550 CARB0NI`RASI L'Or, PHASE 1, LA 0UINTA, CA CEILINGS: TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-38 WALLS: TYPE: BATTS MANUFACTURER: Certainteed THICKNESS: R-21 GENERAL CONTRACTOR: SPARKS CONSTRUCTION LICENSE # BY: TITLE: PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517 BY TITLE: ACCOUNT REPRESENTIVE DATE: L0 39Vd QIWHOS N09ddd Tb8TLbE09LT Zb:ET 900Z/LZ/90-