08-1930 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
08-000039340.
8.16-51 CHARISMATIC WY
767-200-9.9:9-51 -.3120'21-
WALL/FENCE
LOW DENSITY RESIDENTIAL
275
Architect or Engineer:
L'a -,, 94 4< /Tt- /A-
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
----------------------------------------- -----------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that*l am licensed under provisions of. Chapter 9 (commencing with
Section 7000) of'Division 3 of the Businessland Professionals Code, and my License is in full force and effect.
License Class: B No.: 753190
O.
Date '0 "&S Contractor:
OWNER -BUILDER DECIKRATION
I 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, alter, improve, demolish„ or repair:any'strueture,.prior to its issuance; also requires the applicant for the
permit to file a.signedstatement thathe or she is licensed pursuant to the,provisions of the,Contractor's State
License Law (Chapter (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. Anyviolation.of Section 7031..5 by
any applicant fora peimit subjects the applicantto a civil penalty of not more than five hundred dollars 1$500).:
(_) I, as owner of the -property, -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, Busirtess.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 or herself 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 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.).
y _) I, as owner of the propeny,.am exclusively contracting with licensed,contractors to.construct the•projecb(Sec.
7044; Business and Professions Code: The Contractors' State License Law does novapply 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. , B4P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is aconstruction lending agency for the,performanceof the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/08/08
Owner:
DESERT CHEYENNE,, INC.
78401 HIGHWAY 111, SUITE G.
LA QUINTA, CA 92253
(760)777-9920
Contractor:
HERINGTON DEVELOP INC, JAMES O
40960 CALIFORNIA OAKS RD, #283
MURRIETA, CA 92562
(951)677'-8415
Lic. No.: 753190
------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under'penalty of perjury one of the following declarations:
_ I havwand 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.
_ 1 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 for whichthis permit is issued, I shall not employ any
person in any manner so as to become;subjectto the workers' compensation laws of California,
and agree that, if .1 should become subject io the workers' compensation provisions of Section
3700 of the Labor Code, I sh II forthwith co those visions.
Date�_� �DPIlcent: f
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAG UNLAWFUL; AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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, 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'work1s 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 theabove information is,eorrect: I agree to comply wiWall
city and county ordinances and state laws.reladng to building construction,°and hereby authorize representatives
of this
/county to a t r on the above-mentioned property f - ' spacti urpo
Date: i'Or Suture (Applicant or Agent):
Application Number . . .' . . 08-00001930
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 15.00
Plan Check
Fee
.00
Issue Date . . .
Valuation
. . .
275
Expiration Date . . 6/06/09
Qty Unit Charge Per
'Extension
BASE FEE
15.00
Special Notes and Comments
11 LN FT X 6 FT HT GARDEN WALL/
PRECISION BLOCK PER ORCO STANDARDS.
Fee summaryCharged Paid
Credited
Due
Permit Fee Total_ 15.00
.00
.00
15..00
Plan Check Total .00
.0.0
.00
.00
Grand Total 15.00
.00
.00
15.00
LQPE "Aff
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