06-2034 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
•LArQUINTA, CALIFORNIA 92253
Application Number: 06-00002034
Property Address: (81706 RANCHO SANTANA DR
APN: 767 -200 -999 -4 -312021 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2925
Applicant:
T-,�dtt 4 .fw4"
Architect or Engineer:
y P,
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
'Licens lass: B • A License No.: 728102
ate ontractor: 1.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury at 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 file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 o the Business and Professions Code) or
that he or she is exempt therefrom arid 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).:
(_ 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
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.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed -contractors to 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.).
(_ 1 I am exempt under Sec. ,,B.&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: 1
Lender's Address: NII- ••
LQPERMIT
Owner:
LENNAR HOMES
40004 COOK STREET
PALM DESERT, CA 92211
(760)777-9920
Contractor:
LENNAR.HOMES OF CALIFORN
40004 COOK ST.
PALM'DFSERT, CA 92211
(760)601-3100
Lic. No.: 728102
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/15/06
D Q D
I I MAY 2 4 2006
CITY OF LA QUINTA
FINANCE DEPT.
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.
AI 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 OLD REPUBLIC IN Policy Number MWC11148500
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I sho become subject to the workers' compensation provisions of Section
700 of the Labo e; shall forth with comply with those provisions.
D Iccant:
WARM G: ILRV E TO SECURE WOR RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN 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 of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. ' Each person upon whose behalfthisapplication is made, each person at whose request and for
whose benefit work is performedunder 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 Ouinta, 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 riot 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 at I have read this application and state that t above isnformation is correct. I agree to comply with all
city an county ordinances and state laws relating to bu' di construction, and hereby authorize representatives
of th' unty to enter upon the above-mentioned prop fo inspect ri purposes.
at rgnature (Applicant or Agent):
Application Number . . . . . 06-00002034
Permit WALL/FENCE PERMIT
Additional desc ..
Permit Fee 54.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 2925
Expiration Date.. 11/11/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
. 1.00 9.0000 THOU BLDG 2,001-25,000
9.00
----------------------------------------------------------------------------
Special Notes and Comments
117 L.F. 6- GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid
Credited
Due
Permit Fee Total 54.00
.00
.00
54.00
Plan Check Total .00
.00
00
.00
Grand Total 54.00
.00
.00
54.00