06-0795 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA
92253
Application Number:
LM6-00000795
Property Address:
51205 CALLE QUITO
APN:
770-143-009-109 -000000.--
000000.--Application
Applicationdescription:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
7665
Applicant:
Architect or Engineer:
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 Prof Cod d my License is in full force and effect.
License ass: ens 1834
Date " , 911 Contractor.e:-•::.
�am
UILDER DECLARATION
I hereby affirm under penaltylof perjfrom 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 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).:
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.).
(_) 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-forthe projects with a contractor(s)-licensed
pursuant to the Contractors' State License Law.).
(_ I 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:
Lender's Address:
LQPERM[T
VOICE (760) 777-7012
'FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/24/06
Owner:
BRAUCKMANN INC
50855 WASHINGTON ST # 227
LA QUINTA, CA 92253
VFES,
pContractor: 2 4 2005
BRAUCKMANN INCt1t1
50855 WASHINGTON STREET, #227 Ci7'YdF�f�t�i
LA QUINTA, CA 92253
FINANC! FpT.
(760)485-9269
Lic. No.: 781834
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 number are:
Carrier EXEMPT Policy Number EXEMPT
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 o sation laws of California,
and agree that, if I should become o the erg mpensation provisions of Section
3-- F`0 of the Labor Code orthwi[h t those provisions.
pa`I1 2 fXf Applicant:.
WARNI G: F ILURE TO SECURE WORKERS'- 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 behalf thisapplicationis 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 info A�thyorize
lee to comply with all
city and county ordinances and state laws relating to buildin representatives
of this cou y to nter upon the above-mentioned pro o
Date ®Signature-lApplicant or A ntl:
Application Number . . . . . 06-00000795
Permit . . .. WALL/FENCE PERMIT
Additional desc .
Permit Fee 99.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 7665
-, Expiration Date 8/23/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
6:00 9.0000 THOU BLDG 2,001-25,000
54.00
-----------------------------------------------
Special Notes.and Comments
220 LF 6' BLOCK WALL & 100 LF 5- BLOCK
WALLPER ORCO STANDARD & SFD PLAN
Fee summary Charged Paid
Credited
Due
Permit Fee Total 99.00
.00
.00
99.00
Plan Check Total .00
.00
.00
.00
Grand Total 99.00
.00
.00
99.00
LQPERMIT -