05-3658 (BLCK)P.O.:BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00003658
Property Address: 81644 CHARISMATIC WY
APN: 767-200-999-37 -312021-
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3975
T4'1t 4 4 Q"
Applicant: Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
A--&-
AUG 192005
CITY OF LA QUINTA
FINANCE DEPT.
I hereby affirm under penalty of perjury that I am, licensed under proylsionmof Chapter 9 (commencing with
Section 7000) of Division 3 o the Business and Professionals Code, and my Licensure in full force and effect.
License Class: EL Ucens 53190
oe,Piie:. Contracts;.
CLARATION
I hereby affirm under penalty of perjury that I am,exemptfrom, 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; alter, improve, demolish, or repair any structure, prior to its issuance, also requires the "applicant"for the
permit to fila a signed statement thathe orshe 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 thealleged exemption. Any violation of Section 7031:5 by
any applicant fora permit subjects the applicant to a civil penalty of not morethan five hundred dollars (8500).:
(_ I I, as owner of the -or my employees with wages as their sole compensation; will do the work, and
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 orherself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building orlm"pmysment is sold within
one year of complstion,.the owrier-builder will have the burden of proving that he or she did not build or
Improve"for the, purpose 0 sale.):"
(_) I, as ownerof the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: Thi 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 contractor(s) licensed
pursuant,to the Contractors' State License. Law.).
(_) I am exempt'under'Sec. Bt&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 of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: IV \AN
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/18/05
Owner:
DESERT ELITE, INC.
7.8401: HIGHWAY 111, SUITE G
LA 4UINTA, CA 92253
(760)777-992"0
Contractor:
HERINGTON DEVELOPMENT, JAMES O
40960 CALIFORNIA OAKS RD, .#283
MURRIET-A, CA 92562
(9.51.)677-8415
Lic. No.: 753190
WORKER'S COMPENSATION DECLARATION
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 which this 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'carrierand policy number are:
Carrier STATE FUND Policy Number
_ I certify that, in the performance of the work for which this permit is issued, I shalLnot employ any
person in any manner so as to become subject to the workers' compensation,laws of California,
and agree that; if I should become subject to the workers' compensation, provisions of Section
3700 of the Labor Code -shall forthwithO.OZZI
sions.
/ p plicarrt
WARNING: FAILURE TO SECURE W RKERS' CO PENSATION COVERAGE IS 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 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 permitaubject 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 perrnitissued-as,a result of this application,
the owner, and the _applicant, each agress:to, and shall defend, indsmnify,and hold harmless the City
of La Ouinta, its officers, agents and. employees' for anyr 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
pertnh to cancellation.
I certify that l have read this application and state that the above information is correct. I agree to comply with all
city and county-ordinances;andstatei laws relating to building construction, and hereby utho'ie representatives
Lof [thisa my o enter upo above-mentioned property f r inspection purposes.
tgnature (Applicant_ or Agei
Application Number . . . . . 05-0.0003658
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee 63.00
Plan Check Fee
.00'
Issue Date . . .
Valuation . . .
. 3975
Expiration Date . . 2/14/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU BLDG
2,001-25,•000
18.00
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Special Notes and Comments
159 L.F. 6' GARDEN WALL., ORCO SYSTEM
Fee summary Charged
Paid Credited
Due•
Permit Fee Total 63.00
.00 .00
63.00
Plan Check Total .00
.00 .00
.00
Grand Total 63.00
.00 .00
63.00
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