06-4186 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/04/06
Application Number: 06-00004186—"
Owner:
Property Address: (81853 RANCHO SANTANA DR
DESERT ELITE INC..
APN: 767-200-999-25 -312023-
78401 HIGHWAY 111, SUITE G
Application description: WALL/FENCE
LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
(760) 777-9920
Application valuation: 4500
Contractor:
Applicant: Architect or Engineer:
HERINGTON DEVELOPMENT, JAMES O,
/
40960 CALIFORNIA -OAKS RD, 4283
MURRIETA, CA 92562
It's
�.I lry
(951) 677-8415
Lic. No.: 753190
-------------------------7-----------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury at 1 am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Busi s nd Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Clas : License No.: 753190
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
oral ( 6 Cef{ractor:
issued. .
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: '
I hereby affirm'under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FLTND Policy Number 1542746-2006
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to_
I certify that, in the pe ormance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any mann o as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I s Id become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
' 3,700 of the Labor C , I shall forthwith comply with those provisions.
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 ($500).:
�� ( ♦k ;cant:
1 _ 1 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, Business and Professions Code: The
WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
Date: Owner:
CONSTRUCTION LENDING AGENCY
1 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:
LQPERAIIT
of La Quinta, 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 work is not commenced
within 180 days from date of issuance f such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state tha the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to i ing construction, and hereby authorize representatives
of this
counp to nter upon the above-mentioned pro y for inspection purposes.
�'-ure(Applicant or Agent):
Application Number . . . . . 06-00004186
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 72.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 4500
Expiration Date 6/02/07
Qty Unit Charge Pet
Extension
BASE
FEE
45.00
3.00 9.0000 THOU BLDG
2,001-25,000
27.00
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Special Notes and Comments
180 L.F. 6' GARDEN WALL AT SIDE AND
REAR PL, ORCO SYSTEM
Fee summary. Charged
Paid Credited
Due
Permit Fee Total 72.00
.00
.00
72.00
Plan Check Total .00
.00
.00
.00
Grand Total 72.00
.00
.00
72.00
LQPERMIT