08-1615 (BLCK)s ><
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
08-00001615
Property Address:
78658 PEERLESS PL
APN:
770-310-007- - -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY. RESIDENTIAL
Application valuation:
6495
Applicant: Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
KNAPP DUANE E
-2415 T AVE STE 210
ANACORTES, WA 98221
Contractor.
TESERRA
P.O. BOX 1280 Lr�1
COACHELLA GPS 36 ryPj
(760) 398-9222 - QCT 3 o G�l�b
Lic. No.: 656y 8
Date: 10/30/08
' LICENSED CONTRACTOR'S DECLARATION
- WORKER'S COMPENSATIOW DECLARATION
I hereby affirm under penalty of -perjury that:l am licensed under provisiorie_of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:'
Section 700 0) of -Division 3 of the Business and 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 Class C ".C27 -.C29 A�se13 128 _
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for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
o• Og
Date:- ,Coritractor:
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
_
Code, for theperformance of the work for which this permit is issued. My workers' compensation
- '- OWNER -BUILDER DECLARATION -
-� insurance carrieriand policy number are: -
1 hereby affirm under penalty of_perjury that I am exempt from the Contractor's State License Lawforthe
Carrier SEABRIGHT Policy Number BB10805,10.r
• following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that.requires a;permiito
,L certify thatr,in the'performance 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 manner so 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'§'State
*of
and agree that, if I should become ubject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing withSection 7000) of Division.3 the Business and Professions Code) or
- 3 00, of the Labor Cod I shall f hwith comply, with those provisions.
that•he.or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031r.5 by
any applicantfor a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.:
ate . O.Oi. iA )) -
1 _ ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
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the structure isnot intended'or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE}TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State.License Law does not.apply to an owner of property who builds o?improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND'CIVIL-FINES UP TO,ONE HUNDRED THOUSAND
and who does IheIwork himself or herself through.his or her own employees, provided that the
DOLLARS (s100',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
(_) I, as owner of the property; am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Applicationis 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'upor 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,
(_ 1 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
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:
LQPERMIT
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 ifwork 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.
1 certify that I have read this application and state that the above information is correct. I agree to comply with all
.city and county ordinances and state laws gelating to building onst"" bJon, and hereby authorize representatives
of this W
en/!r r upon the above-mentioned property for ' pec '6n purposes.
tiADate_Signature (Applicant or Agent):
�.,rsrdr.�:;r,:
.01
Application Number . . . . . 08-00001615
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 90.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 6495
Expiration Date . . 4/28/09
Qty Unit Charge Per Extension
BASE FEE 45.00
5.00 9.0000 THOU BLDG 2,001-25,000 45.00
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Special Notes and Comments
SACRIFICIAL RETAINING WALL, 300 L.F. OF
5' HIGH WALL;. WITH WROUGHT IRON PER
APPROVED PLANS.
Fee summary Charged Paid Credited. Due
---------------------------------------------------------
Permit Fee Total 90.00 .00 .00 90.00
Plan Check Total .00 .00 .00 .00
Grand Total 90.00 .00 .00 90.00
LQPERMIT