04-6960 (BLCK)BUILDING & SAFETY DEPARTMENT
P.O. Box 1.504 (760),777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA Q.UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
Application Number . .
Property Address . . .
APN:
Application description
Property Zoning .
Application valuation .
BUILDING PERMIT
. 04 00006960 Date 10/26/04
. 7720:2 CASA DEL SOL
7'73-36:0-0:04-
WALL/FENCE
73-36:0-0°04-WALL/FENCE
. . . MEDIUM DENSITY RES'
4749
Owner Contractor
HUETTNER RICHARD SANTA ROSA,BUILDERS, INC..
74301 ERIN ST P.O. BOX 113.35
PALM DESERT CA 9.2260 PALM DESERT CA 92255
WCC: STATE FUND
WC: 177037904 01/01/05
CSLB: B 10/31/04
CCC,: 814110
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Permit . . . . WALL/FENCE PERMIT'
Additional desc .
Permit Fee . . . . 72.00 Plan Check Fee .00
Issue Date . . . . Valuation . . 4749
Qty Unit Charge Per Extension
BASE FEE 4.5.00
3.00 9.0000 THOU BLDG 2,001-25,000 27.00
Special Notes and Comments
125 L.F. COMBO WALL,.2- RETAINING, 5'
GARDEN & 75 L.F. 5' GARDEN WALL, BOTH
CITY STANDARD
Fee summary Charged
Permit Fee Total 72..00
Plan Check Total .00
Gran Qral_ 72.00
OCT 2 G 2004
CITY Cr- LA QUINTA
Paid Credited Due
.00 .00 72.00
.00 .00 .00
.00 .00 72.'00
P.O. Box 1504 '�G� � VOICE (760) 777-7012
78-49.5 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 93253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. (0 9 lf0 d Date: /019& • a y
Applicant: I Architect or Engineer:
Applicants Mailing -Address:
Architect .or Engineer's Address:
Lic. No.:
a A
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
thereby affirm under penalty of perjury that I am licensed under, provisions of Chapter 9 (commencing with Sectlon 7000) of Division 3 of the Business and.Protessionals
Code„and my Uctn is infull force and effect. /
�floense Class• 9M .._C,;-se
No. 14 11 c)
/Date 10 Contractor �A AM QQ15., % AA.L%_ftrWJ%J Ltp M
OWNER43UILDER-DECLARATION
I herebyafBrn under penalty,of perjury that tam exempt from the Contractors' State License Law for ft following reason(Sec: 7031.5,, Business and Professions Code: Any
city or county that requires a permit to construct, alter; improve, demolish, or repair anystructure, prior tolls issuance, also requires the applicant,for the permit to file a signed
statement that heor she isiioensed pursuant to the provisions of the.Contracfors' State License Law (Chapter9 (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,exempbon. Any vbletlonof Section 7031.5 by applicant fora pemritsubjects
the applicant to a civil penalty of not more than five hundred dollars ($500):):
U I, as owner of the property, or my employees with wage&as their sole compensation, will do the work, and the structurols'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 orherseB;or through his or her own employees, provided thatdhe 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'improvefcr the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors tD 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 contractor(s) licensed pursuant to
the, Contractors' State License Law.).
U I am exempt under Sec. 8.&, P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
f themork for which4his 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 workior which this permit is
issued. My ��P rs' �co�mppe�nsation p, wance carrier arra pol number are:
crier 451IN&C I \f'LA �+t� � licy Number 113 n 9) 3!3 b d
,—I certify that, in the performance of the work for which this p1linnit is issued, Tsh ll 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, I shall
forthwith comply with those provisions..
WARNING: FAILURE TO SECURE WORKERS' COJPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSANDIDOLLARS ($100,000); IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF -THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application Whereby made to the Director of Building and Safety fora permit subject to the conditions and restdcMions set,forth on this application.
1. Each person upon whom behalf this'appiication is made, each person at whose request and for whose benefitwofk 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 Quinta, its
officers, agents and employees for anyact or omission related to thework 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 thatl have read this•application and state thatthe above nfoation is correct. I agree to comply with all city,and county ordinances and state laws relating to building
construction, and hereby authorize representatives of thimr
s county enter upon the above-mentioned property for inspection purposes.
ate b dignature (Applicant or Agent):