06-0985 (BLCK)P.O. BOX 1504
78-495 CALLE.TAMPICO
LA QUINTA, CALIFORNIA 92253'
Td4t 4 XP Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I.am licensed under provisions of Chapter 9 (commencing with
Section 7 00) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
Licens lass: License No.: 728102
ate: V ntractor. - - ,
OWNER -BUILDER DECLARATION
erj
I hereby affirm under penalty of pury tha I exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business a rofessions 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 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 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, as owner of theproperty, 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.). r
(_) 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: Q
Lender's Address:
LQPERMTT
Date: 3/10/06
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
7` 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 should become subject to the workers' compensation provisions of Section
700 of the Labor o e, I shall forthwith comply with those provisions.
Xate: pp n.
WARNING: FAILURE TO SECURE WO KE S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI AL P NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,000). IN ADDITIO 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 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 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 with all
Nate:
4ordi ances and state la' el ' to building construction, and hereby authorize representatives
r up the above lone property for in pection purposes.
log
(Applic e
Application Number:
`06`00000985
Owner:
Property Address:
81559-RANCHO-SANTANA DR
LENNAR HOMES OF
CALIFORNIA
APN:
767-200-999-56 -312022-
40004 COOK STREET
Application description:
WALL/FENCE
M DESERT, CA
92211
Property Zoning:
Application valuation:
LOW DENSITY .RESIDENTIAL
9150
D 0.
0) 777-9920
C
MAR 2 0
ractor:
Applicant:
Architect or Engineer:
E � AR HOMES OF
CALIFORNIA INC
�iT1f OF �Qu� A
400 4 COOK ST.
P DESERT, CA
92211
COO/
N
(760)601-3100
Lic. No.: 728102
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I.am licensed under provisions of Chapter 9 (commencing with
Section 7 00) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
Licens lass: License No.: 728102
ate: V ntractor. - - ,
OWNER -BUILDER DECLARATION
erj
I hereby affirm under penalty of pury tha I exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business a rofessions 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 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 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, as owner of theproperty, 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.). r
(_) 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: Q
Lender's Address:
LQPERMTT
Date: 3/10/06
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
7` 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 should become subject to the workers' compensation provisions of Section
700 of the Labor o e, I shall forthwith comply with those provisions.
Xate: pp n.
WARNING: FAILURE TO SECURE WO KE S' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI AL P NALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,000). IN ADDITIO 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 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 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 with all
Nate:
4ordi ances and state la' el ' to building construction, and hereby authorize representatives
r up the above lone property for in pection purposes.
log
(Applic e
Application Number . ... . . 06-00000985
Permit . .
. WALL/FENCE
PERMIT
Additional desc .
Permit Fee
117.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 9150
Expiration Date
9/06/06
Qty Unit Charge
Per.
Extension
BASE
FEE
45.00
8.00 9.0000
THOU BLDG
2,001-25,000
72.00
-----------------------------------------------
Special Notes and
Comments
----------------------------
366 L.F. 6- GARDEN
WALL, ORCO SYSTEM
Fee summary
-----------------
Charged
----------
Paid Credited
Due
e_ Permit Fee Total
----------
117.00
----------
.00
----------
.00
117.00
Plan Check Total
.00
.00
00
.00
Grand Total
117.00
.00
.00
117.00
r.
LQPERMIT
1