05-4431 (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:
05-0000443.1
81587 CHARISMATIC WY
767-200-99.9-47 -312021-
WALL/FENCE
LOW DENSITY RESIDENTIAL
240
Architect or Engi
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 7000) of Division 3 of the Business and Professionals Code, and my License is In full force and effect.
License Class: B License bio.: ' 753190
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason,(See. 7031.6, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repairany 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 isnot intended or offered for sale (Sec. 7044, Business and Professions Coder The
Contractors' State License Law does notapply to an owner of property who buikls.or improvesithereon,
and who does the work himself or herself through his or her own employees, provided that
improvements are. not intended or offered for sale. ff, however, the building or improvement is sold within
one year of completion, the owner -builder will, have the burden of proving.that heor she did not.build or
improve for the purpose of sale.).
(_) 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 Lew does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law:).
1 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 &constructionlending agency for the performance of the
work for this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Data: 10/03/05
Owner:
DESERT CHEYENNE, INC.
78401 HIGHWAY 111, SUITE G
LA QUINTA, CA .92253
(
Contractor:
HERINGTON DEVELOPMENT, JAMES O
40960 CALIFORNIA OAKS RD., #283
MURRIETA, CA 92562
(951)677-8.415
LiC,. No.: 753,190
-------------------
WORKER'S COMPENSATION DECLARATION
'1 hereby affirm.under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to seff-insure forworkers' 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 bySection 3700 of the Labor
Code, fomite performanceof the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 1542746
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,
and agree that, if f should become subject.to the.workers' compensationprovision>s of. Section
/00 of the Le _ r Code, l shall forthwith comp itl hose pr Slone.
/per/t � licartt: �' a�irt
WARNING FAI RE70 SECURE'WORKERS' COMRENSATION COVERAGE IS NLAWFUL, 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 FOWIN
SECTION 3706 OF THE'LABOR'CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Oirectorof Building and Safety for 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 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 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 1 have read this application and state that the above information is correct. I agree to comply with all
city -and county ordinances and state laws relating to building construction, and hereby author' a representatives
of thi oumy to enteruto on' above-mentioned property for inspection purposes
a � � 0061 re (Applicant or Agent:LOCI. �V
LQrERMIT
Application Number
Permit. . . .
Additional desc .
Permit Fee . . . .
Issue Date : .
Expiration Date . .
. . . 05-00004431
WALL/FENCE PERMIT
15.00
4/01/06
Plan Check Fee . . .0.0
Valuation . . . . 240
Qty Unit Charge Per Extension
BASE FEE 15.00
----------------- -- - - -----
Special Notes and Comments
15 L.F. 4' COURTYARD WALL, ORCO SYSTEM
Fee summary Charged. Paid Credited Due
----------------- ---------- ---------- ------ - --- -
Permit Fee Total 15.00 .00 .00 15.00
Plan Check Total .00 .00 .06 .00
Grand Total 15.00 .00 .00 15.00