05-3915 (BLCK)P.O. BOX 1504-
78-495.CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4hi 4 4Qu&&
BUILDING & SAFEWDEPARTIVIENT
BUILDING PERMIT
Application Number: 05-0.0003915 Owner:
Property Address: 81619 CHARISMATIC WY DESERT ELITE, INC.
APN: 767-200-999-4.9 -312021- 78401 HIGHWAY 111., SUITE G
Application description: WALL/FENCE O LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL 760) 777-9920
Application valuation: 4550 /1
Applicant:
hereby affirm under penalty of perjury
'sction,7090) of Division 3 of the Bus!,
?A r
Architect or Engineer:
/A
9NSED CONTRACTOR'S DECLARATION
am licensed under provisions of..Chapter 9 (commencing with
id Professionals Code; and my License is in full force and effect_.
License No.: 753190
J OWNER-BUILOER DECLARATION
I hereby affirm under penalty of perjury that 1 am exemptfrom the Contractor's State License' Lawlor the
following reason (Sec. 7031.5, Business and Professions Code: ,Any city or county that requires a permit to
construct, after; 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's (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 (95001.:
1 _) 1, as owner of the property, or my employees.with wages as their sole compensation, will do the work, and 10
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 ovherself 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. of2 completion, the owner -builder will have the burden of proving that he or she did not buildor
improve for the purpose of sale:):
(_) I, as owner of the property, am exclusively contracting with licensed contrectors to construct the project (Sec..
7044, Business and Professions Code: The Contractors' State.L)cense 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—) I am exempt under Sec. , B.&P;C. for this reason.
Date: Owner:
CONSTRUCTION LENDING AGENCY
'I hereby affirm under penaftyof 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:��
LQPERBUT
DEVELOPMENT,
IFORNIA OAKS
CA 92562
8415
753190
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
JAMES O
RD, #2'83
Date: 9/08/05
WORKER'S COMPENSATION DECLARATION
I hereby. affirm under penalty ofperjuryone cf-the following declarations:
I have and will. maintain a certificate of consent to self -insure for workers' compensation, as provided
for by. Section 9700. of the Labor Code, for the performance of the work for which this permtris
Issued.
1 have arid, will maintain workers' compensation insurance, as required by :Section 3700 of the Labor
Code, for the performance of the work for which this permitis issued. My workers' compensation
insurance.carrier and policy number are:
Carrier STATE FUND Policy Number 1542746
I certify that, in the perfor ce of the work for which thisVermit is Issued, I,shall notemploy any
person in any manner so to become subject.to the workers' compensation laws of California,
Brad agree that,'if l shoul ome,subject to the workers' compen sationprovisions of, Section
X700 of�bor Cod shall forthwith comply with thou provisions.
nra• 9 r r nlirnm�
WARNING: FAILURE TO SECURE WO KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (9100,000): 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.Safetyfora permit:subject.to the
conditions and restrictions set forth an this, application.
1. Each person upon whose behalf this applicatlon.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, indemnity and hold harmless the City
of La Ouinta, its officers, agents and, empioyeeaforany 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 of such permit, or cessation, of work,for 180 days will subject
permit,to cancellation.
I certify that I' have read this application and state that -t a e information is correct. I agree to comply with all
city and county ordinances and state laws relating to bui i construction, and hereby authorize representatives
Dthi co�fty enter upon t above-mentioned prope r inspection purposes.
/ nature (Applicant or Agent):;
Application Number . . . 05-00003915
Permit . .
. WALL/FENCE
PERMIT
Additional desc
.
Permit Pee
72.0.0
Plan Check Fee
.00
Issue.Date .
.
Valuation . . .
. 4550
Expiration.Date .
3/07/06
Qty Unit Charge_
Per
Extension
BASE
FEE
45.00
- 3.00 9.0000
THOU BLDG
2,.001-25,000
27.00
-----------------------------------------------------
Special Notes and
Comments
--------------
182 L.F. 6' GARDEN
WALL, CITY STANDARD
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
.00 .00
72.00