05-3916 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00003916
Property Address: 8163.5 CHARISMATIC WY
APN: 767-200-999-50 -312021-
Application description: WALL/FENCE
Property Zoning:. LOW DENSITY RESIDENTIAL
Application valuation: 4550
Applicant:
I hereby affirm under penalty of pe
Section 7000) of Division_ 3 of the
License C196: if
Architect or En
P !k
T4ht °F 4 Qm&m
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner'
DESERT ELITE, INC.
7840.1 HIGHWAY 111, SUITE G'
LA QUINTA, CA 92253
(760')777-9.920
Contractor:
HERINGTON DEVELOPMENT, JAMES O
40960 CALIFORNIA OAKS RD, #283
MURRIETA, CA 92562
(951)677-8415
Lie. No..: 753190
Date: 9/08/05
ENSED CONTRACTOR'S. DECLARATION WORKER'S COMPENSATION DECLARATION'
am licensed under provisions of Chapter 9 (commencing with I hereby affirm,under penalty ofperjury one of.the following declarations:
rid Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to setf-insure for workers',compensetion, as provided
License No.: 753190 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Xthave and will maintain workers' compensation insurance, as required by Section 3700 of the labor
Code, fortha performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of'perjuit(hat I am exempt from the Contractor's State LicenseLawfor the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county.that requires -a permit to
construct,slter,,improve, demolish, or repeirany structure, prior to its issuance, also requires the applicent,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) ofDivision 3 of the Business and Professions CodeYor
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 (4500).:
1 _)
1, as owner of the property, or my employeeswith wages as their sole compensation, will do the work, and
thestructure.is.not intended or offered for sale, (Sec. 7044, Business and Professions Code: 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 that the
improvements are not intended or offered forsale. 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.forthe purpose of selaJ.
(_ 1 I, as:owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractor' State License 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.).,
(_ 1 I am exempt.under Sec. _ , W&P.C. for this reason
Dote:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty ofperjury that there is a construction,lending-agency for the performance of the
work ,forwhich this permit is issued (Sec. 3097, Civ. C:):
Lender's Name:
Lender's Address: -
LQPERMIT
WARNING: FAILURE TO SECURE.WORK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100;000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 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 harmless the City
of La Quints, its;officers; agentsand'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 resulvoUthis application becomes null and void if work is not commenced
within ISO days from date of issuance of s ch permit, or cessation of work,for ISO days will subject
permit to cancellation..
I certify that I have read this application and state that t bove information'is correct. I agree to comply with all
city and cou y d�=a
a laws relating to bui construction, and hereby authorize representatives
ofth' C envementionedprops orinspection purposes.
T If licam or Agent):,
insurance carrier and policy number are:
Carrier STATE FUND
olicy Number
I certify that, in the,performan
he work for which this permit is issued, I shall not empioyany
person in any manner so as o
ome subject.to the workers' compensation laws of California,
and agree that, if.fshould c
00 of the I -bar Code, I:
subject to the,workers' compensation provisions -of Section
forthwith comply with those provisions.
ate/�9�
i plicant:
WARNING: FAILURE TO SECURE.WORK S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100;000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 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 harmless the City
of La Quints, its;officers; agentsand'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 resulvoUthis application becomes null and void if work is not commenced
within ISO days from date of issuance of s ch permit, or cessation of work,for ISO days will subject
permit to cancellation..
I certify that I have read this application and state that t bove information'is correct. I agree to comply with all
city and cou y d�=a
a laws relating to bui construction, and hereby authorize representatives
ofth' C envementionedprops orinspection purposes.
T If licam or Agent):,
Application Number . . . . . 05-0000-3916
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 72.00
Plan Check_
Fee
.00*
Issue Date. . . . .
Valuation
. . .
. 4550
Expiration Date . . 3/07/06
' Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.000.0 THOU BLDG 2,001-25,000
27.00
------------------;----------------°-----------------------------------------
Special Notes and Comments
182 L.F. 61 -GARDEN WALL, CITY STANDARD
Fee summary Charged Paid
Credited
Due
Permit Fee Total 72.00
.00
.00
7.2.00
Plan Check Total .00
.00
.00
.60
Grand Total 72.00
.00
.00
72.00
LQrERMre