05-3659 (BLCK)-i.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00003659
Property Address:
81628 CHARISMATIC WY
APN:
767-200-999-38 -3'12021-
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITYRESIDENTIAL
Application valuation:
4475 IID
Applicant: Architect. or
I�
r x r
----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Date: 8/18/05
Owner:
DESERT ELITE, INC.
78401 HIGHWAY 111, SUITE G
LA QUINTA, CA 92253
(760)777-9920
e
AUG 19 1005 Contractor:
HERINGTON DEVELOPMENT, JAMES O
40960 CALIFORNIA OAKS RD, #283
;ITYOFLAQUINTA MURRIETA, CA 92562
FINANCE DEPT. ('951) 677-8415
Lia.. No.: 753190
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code,. and my.Ucense is in full force and effect.
Licenseasbs: B OR Lit a : - 753190
Date i 7 d0f Contractor: 66464
OWNER -BUILDER SLARA?ON
(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, after, improve, demolish,or repair, any structure, prior to its issuance, also requires the applicant for the
permit to fib a signed statement that he or she is licensed pursuant to thWprovisions of the Contractor's,State
License Law. (Chapter.9 (commencing with Section 7000) of Division 3 of the Business and'Profeasions Code) or
that he or sire 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 (6500):
(_) 1, as owner of the property, or my employees with wages as their sole,compensation, will do the work, and 41
the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Coda The
Contractors' State License Law does not apply toan owner of property who -builds or improves thereon,
and who does the work himself or herself through his or'her own employees, provided thacthe
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.).
(_) I, as owner ofthe 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 contrector(s) licensed
pursuant to the Contractors"State License Law.).
(_ 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 ofthe
work for which this permit is issued (Sec. 3097, Civ. C'.).
Lender's Name:
Lender's Address:
------------------
WORKER'S COMPENSATIONDECLARATION
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 whichthis permit is
�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
insurance carrier and policy number are:
Carrier .STATE 'FUND Policy Number
_ 1 certify that, in the performance of the work fm'which this permit is issued; 1 shall not employany
person in any manner so as to become subject to the -workers'' compensation laws of California,
and agree that, if 1 should become subject to the wor erpppps'ggqqcccceeeompensation provisions of Section
3700 of.the Labor Code; f s II forthwith comply prov 'oris.
e > f item {tea.
WARNING: FAILURE TO SECURE W KERS' COMPENSATION COVERAGE UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL.PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (6100,000). IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE .LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDG'EME1fIT
IMPORTANT Application is hereby made to thwDirector of Building and Safety for a permitsubject to the
conditions and restrictions set: .
forth ,an this application.
1. Each person upon whose behalf this application Is,made,.sech 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 0uinta, 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 ISO 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 thi&applicstionand state that the above information°is correct. I to comply with all
city so county ordinances 'and ate laws relating to building construction, and hereby:a rize representatives
of this ou ty to ter upo above-mentioned props f spaction.pu
ate: &; gnsture-(Applicant or Agentl:
Application Number . . . . . 05-00003659
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee' 72.00
Plan .Check
Fee
.00
Issue Date
Valuation
. . .
. 4475
Expiration Date 2/14/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,00.0
27.00
-------------------
------------------------------------------------------------------
Special Notes and Comments
Special
------------------------
-------------
179 L.F. 61 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
.06
.00
72.00