05-1280 (BLCK)z
BUILDING & SAFETY DEPARTMENT
w� O. BOX 1504 (760).777-7012
O -495 CALLS TAMPICO FAX (760) 777-7011
UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
V G`�Nj
\App,Plcation Number .0'S 0001.2;80 .; Date 4/06/05
Pfoperty Address 60088 PRICKLY „PEAR LN
APN: 764-270-999-36 -300232-
-.Application description WALL/FENCE
Property Zoning . . . . . . . MEDIUM HIGH DENSITY RES
Application valuation 1005
Owner Contractor
WENGER, ROD & KATHY OROS�BROS MASONRY
60088 PRICKLY PEAR'LANE 82108 SUNDOWN CT
LA QUINTA CA 92253 INDIO CA 92201
(760) 578-6837
WCC': STATE FUND
WC: 1744804-.'' 10/01/05
CSLB: 826241 .'10/31/05
CCC: C29
Permit . . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 27.00 Plan Check Fee .00
Issue Date Valuation . . . . 1005
Qty' Unit. Charge Per Extension
BASE FEE 15.00
6.00 2.0000 HND BLDG 501-2„000 12.00
-----------------------------------------------------------------------------
Special Notes and Comments
55 LF 4' BLOCK WALL PER CITY STANDARD
WITH 5 6' COLUMNS.
Fee summary Charged Paid Credited Due
Permit Fee Total 27.00: .00 .00. 27.00
Plan Check Total .00 .00 .00 .00
Grand Total 27.00 ..00 .00 27.00
0
P.O. Box 1504/�'J��
78-495 CALLS TAMPICO � j� rl VOICE (760) 777-7012
LA.QUINTA, CALIFORNIA 92253 4FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
Application Number: 0(-5-- 12r-0
An lic Date:
p at
n .
Applicant's Mailing Address:
Architect or Engineer:
Hrcrinect or tngjneer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (coencing with Section 7000) of Division 3 of the Business and Professionals
Code and my License is in full force and effect.
u nse,A. 109
ns
��6 Z ym
CelNo.
Dte -= S ✓
on actor'
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 or 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 for the projects with a contractoi(s) licensed pursuant to
the Contractors' State License Law.).
L) I am exempt under Sec. , BA P.C. for this reason
Date
I hereby affirm under penalty of perjury one of the following dec arraattiionsRS' COMPENSATION DECLARATION
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.
Jt.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
�,�ssued. Mxworkers' compensation -insurance carrier agglie oy
f Caill�er _ q T� T�✓ olicy N tuber jSG. b (/ a�:
I certify that, in the performance of the work forwh ch 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 agre hat, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPYKATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DO RS ($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.
CONSTRUCTION
I hereby affirm under penalty of perjury that there is a construction lend ng age cyothe performance AGENCY
of he work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT
IMPORTANT Application is hereby made to the Director of Buildin and SaCKNOWLEDGEMENT
T ACKNOWLEDGEMENT
set forth on this application.
1. Each person upon whose behalf this application is made, each person at permit
en ser request and for whose benefit work isnperformed 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 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 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 relating to building
construction, and hereby authorize representatives of this county to enter upon the abov e ' d property for inspection purposes.
= /te' �Signature,(Applicant lorAgent):
I' -