08-1929 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
08-00001929
Property Address:
81.676 CHARISMATIC WY
APN:
767-2.00-999-35 -312021-
Application description:
WALL/FENCE.
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1375
Applicant: Architect or Enginl
C0- A-+
BUILDING &SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DESERT CHEYENNE, INC-.
78401 HIGHWAY 111,, SUITE G
LA QUINTA, CA 92253
(760)777-9920
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:.
d HERINGTON.DEVELOP INC, JAMES O
40960 CALIFORNIA OAKS RD, #283
.MURRIETA,, CA 92.562
DEC. (951)677-8,415
_ %, 1 Q ZOoe Lic . No.: 753,190
---------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I em licensed under' provisions of Chapter 9'(commencing with
Section 7000) of Division.3 of the Business and Professionah�ggCode, and my License is -in full force and effect.
License Class: B _ AAense,ft.: 753190 '
QWNER-BUILDER DECLARATION
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 structure, prior to its issuance, also requires the applicant for the
permit to fiWa signed statement that he or she.is licensed pursuantto the;provisions of the Contractor's State
Licenewl-aw (Chapter 9.(commenting with: Section 7000) of Division 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 applicanvto:a civil penalty of not more than five hundred dollars ($500).:
(_) I; as owner of the property, or my employees with wages as their sole compensation, will do the work, and
thestructure is not intended or offered *for sale ISec. 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of property who buiids or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended oroffered.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.).
1 _ j 1„as.ownerof the property, am exclusively contracting with licensed contractors to constructthe project (Sec.
7044, Business anid'Professions Code: The Contractors' State License.Law does not epply.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.j.
1 _ 1 I.am exempt under Sec. , B.&RC. 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 isJssued (Sec. 3097, Civ: C.).
Lender's Name: _
Lender's Address:
14PERMIT
Date: 12/08/08
--4 - - - --- - - - - - - -- : ---- - - - - - - - - - - - - - - - - - - - - - - --_--
J 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 carrier and policy numbecare:
Carrier STATE FUND Policy Number 1542746-2008
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner sous to become.subject to the workers' compensation laws of. California,
and'agree;that, if I should become subjectto a workers' compensation provisions of Section
3700 of the Labor Code I she[ l forthwith pl t'71it thoprovisions.
Det Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERA E IS UNLAWFUL, AND SHALL
CT
SUBJEAN EMPLOYER TO CRIMINAL PENALTIES 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 oUBuilding.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, he applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quints, its officers, agents and employees for any actor 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 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 the above information is correct. I agree to comply withall
city and county ordinances and state laws relating to building_ construction; and hereby authorize representatives
of this county to enta upon the above-mentioned pr pe rin action p
O.S6Ol
Date: "�-` ignature (Applicant or Agents: -
Application Number- . . . . 08-0000192.9
Permit . . . WALL/FENCE 'PERMIT
Additional desc . .
Permit_ Fee 33.0.0_
Plan Check
Fee
.0.0
Issue Date . . .
Valuation
. . .
. 1375
Expiration Date . . 6/,06/0'9
Qty Unit Charge Per
Extension
BAS& FEE
15.. 0 Q
9.00 2.0000 HND BLDG 501-2,000
.18.0:0
----------------- -------- — _
Special Notes and Comments
_
55 LN FT X 6 FT HT GARDEN WALL /
PRECISION BLOCK.PER ORCO STANDARDS.
Fee summary charged Paid
Credited
-
'Due
----------------- ------ -----------
Permit Fee Total 33.00
- -
.00
.00
33:00
Plan CheckTotal .00
.00
.0.0
..00
Grand Total 33.00
.00
.00
33.00
34.
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