05-3928 (BLCK)4 P.O. BOX 1504 �VOICE (760)'777-7012
78-495 CALLE TAMPICO FAX (760) 777m7011
LA QUINTA, CALIFORNIA 92253 BUILDI & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
ING PERMIT
Date: 9/09/05
Application Number: 05-00003.928 a Owner:
Property Address: 81587 CHARISMATIC WY DESERT ELITE, INC.
APN: 767-200-999-47 -312021- 78401 HIGHWAY 111, SUITE G
Application description: WALL/FENCE C LA QUINTA, CA 92253
Property. Zoning: LOW 'DENSITY RESIDENTIAL �. 0� (760,)777-9920
Application valuation: • 6175 �! ?O
Os D Contractor:
Applicant: Architect or Engineer: HERINGTON DEVELOPMENT, JAMES O
40960 CALIFORNIA OAKS RD, #283
MURRIETA, CA.92562
1 �/L (951)677-8415
Lio. No..: 753190
TRACTOR'S. DECLARATION
LICE?f'onale
I hereby affirm underpenalty of perjury that I aunder
provisions of Chapter 9 (commencing with
Section 700.0) of Division 3 of the Business an
Code, and my License is in full force and.eifect.
Lice ss Cla s:
License No.: 753190
Date ontractor
WNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that)exempt from the- Contrector's:Stete License Law for the
following reason (Sec. 7031:5, Business'andH.io,ns Code: Any crty or county that requires:a permit to
construct, alter, improve, demolish, or repair any structure, priorto.its issuance, also requires the applicarn'•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 (8500).:
1 _) l,, 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 (Sea: 7044, Business and Professions Code: The
Contractors' State License Law does novapply 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 improvemenfis 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.).
(_) I, as owner of the property, am exclusively contracting with licensedcontractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State,Ucense 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.).
(_ )' I am exempt under Sec., , B.&P.C.-for this reason
Date' Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penafty,of perjury that there is a, construction lending agency for the performance of the
woik.for which this permit 'is` cued (Sec. 3097, Civ. CJ.
Lender's Name::
Lender's Address:
LQPERM1T
WORKER'S COMPENSATION DECLARATION
I.hereby affirm under penalty of perjuryoneof the following,declaraiions:
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.
heveAnd will maintainworkers' 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 carrleriand p icy'number are:
Carrier STATE FUND Policy Number- 1542746
_ [certify that, in thelperforr*4no4of the work for which.this permit is issued, I shall not employ any
person in any manner s4 49.0 become subject to the workers' compensation laws of California,
and agree that, if 1 shout ome subject to the,workers' compensation.provisions of Section
�pllcamthe bor Code, all forthwith comply with those provisions.
p:
WARNING: FAILURE TO SECURE WO S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMIN P ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (8100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 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.hermless thwCity
of La Quints, 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 resuit.of this application becomes null and void'if work"is not, commenced
within 180 days from date of issuance tbuilnstruction,
t, orcessa[ionof work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state thnformation Wcorrem I agree to comply whh:all
cityand county ord ances and"state laws relating to and hereby authorize representatives
of this coon to er upon above-mentioned prection purposes.
/' nature (Applicant or Agent):
Application Number . . . . . 0.5-00003928
Permit . . . WALL/FENCE PERMIT
Additional dese .
Permit Fee. . . . . 90.00 Plan Check -Fee .00
Issue Date Valuation 6175
Expiration Date 3/08/06
Qty Unit Charge Per Extension
BASE FEE 45.00
5.00 9:000.0 THOU BLDG 2,001-25„0.00 45.00
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Special Notes and Comments
247 L.F. 6' GARDEN WALL, CITY STANDARD
Fee summary Charged Paid Credited Due
Permit Fee Total 90:00 .00 .00 90.00
Plan Check Total 00 .00 0.0 .00
Grand Total. 90.00 .00 .00 90.00
LQPERMrr