05-3660 (BLCK);s ' :`
P.O. BOX 1504
78-495 CALLE TAMP.ICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Applicationvaluation:
Applicant:
05-00003660
81612 CHARISMATIC WY
767-200-999-39 -312021
WALL/FENCE.
LOW DENSITY RESIDENTIAL
4675
Architect or
T4tyl 4 4 QgAM
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
DESERT ELITE, INC.
784.01 HIGHWAY 111, SUITE G
LA QUINTA, CA 92253
(760)777-9920
Contractor:
HERINGTON DEVELOPMENT, JAMES O
40960 CALIFORNIA OAKS RD, #283
MURRIETA, CA 92562
(951)677-8415
Lic. No.: 753190
Date: 9/18/05
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I amlicensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury ore of the following declarations:
Section 7000) of Division 3 of the,Business and Professionals Code, and my:License:is in full force and effect.
_ I have and will maintain a certificate of consent to cetf-insure for workers' compensation, as provided
License Class: H Li' o.: 753390
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/Date: ontraetor:
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 permit is issued. My workers' compensation
OWNER BUILDE VDECLARATION
insurance"carrier and policy number are:
I hereby affirm under penalty'of perjury that t am;exempt from the Contractor's State Licenselaw for the
Carrier STATE FUND Policy Number 1542746
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the, applicant for the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he,orshe 'is licensed pursuant to the provisions of the Contractor's State
and agree that; if I should, become subject to th workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of`Division 3 of the Business'and-Professions Code) or
3700 of the Labor hall fo ith co y those visions.
that he or she is exempt therefrom and the basis for the:alleged exemption. Any violation of Section 7031:5 by
e
any applicant for a permit subjects the applicant to a civil penalty of not more,than.five hundred dollars (8500).:
ate: r 0 licant:
TORKERS'CO
I,. as owner.of the property, or my employees with wages as their sole,compensation; will do Lire work, and
the.structure.is not intended or offered"for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE PENSATION COVERAG 'IS UNLAWFUL, AND SHALL
Contractors' State.Ucense Law does not apply to an owner of propertywho builds or improves thereon,
SUBJECT. AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his on her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are notintended or offered for sate. If, however, the building or improvement is sold within
SECTION 3708 OF"THE LABOR CODE,.INTEREST, AND.ATTORNEY'S FEES.
oneryear 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 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, anis 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 herebyaffirm under penalty of perjury that there isa 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: = 1. C
LQPERIIIIT
APPLICANT ACKNOWLEOGEMENT
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" requestarid for
whose,benefn 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 "`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 isnot commenced
within ISO days• from date of issuance ofsuch permit; or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read thisapplication 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 aut ize representatives.
oft isy t enter upon above-memioned, property for ' at. n pu Dees.
nature, (Applicant or Agent):
JF
Application Number . . . . . 05-00003660
Permit. . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . 72.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. -4675
Expiration Date 2/14/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-2.5,000.
27.00
- --------------------
Special Notes and Comments
187 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid
Credited
Due
Permit Fee Total 72.00
.00
.00
72.00
Plan Check Total .00
.00
.00
.00
Grand Total 72.00
.0.0
.00
72..0'0