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05-1996 (BLCK)P.O. BOX 1504 ro VOICE 760 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA; CALIFORNIA�92253.. BUILDING & SAFETY DEPARTMENT r INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: _ • 5/24/05 Application Number: 05-00_001996 Owner: Property Address: 58473 QUARRY `RANCH RD QUARRY RANCH, LLC APN: 766-060-999-27 30651 -. 1 QUARRY LANE, LA QUINTA Application description:WALL/FENCE- LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL - Application•valuation: 3075 Contractor: Applicant: Architect or Enginee D C & G CONSTRUCTION COMPANY SAY 2 2p05 965 N. 2ND STREET I UPLAND, CA 91786 (760)123-4567 OF LA,(ilU1NTA CIN DEQ Lic. No.: 692234 FINd>,NCE LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with • I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Busines a Professional od 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 Cl ss: B cen No.: 692234 - for by Section 3.700 of the Labor Code, for the performance of the work for which this permit is issued. nt_ractor:- 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 . OWNER-BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier' STATE FUND Policy Number 179926 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _' I certify that, in the performance of the ork for whi this p it 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 ec a subjec a wor l' compe tion laws of California, permit to file a signed statement that he or she is licensed pursuant tb the provisions of the Contractor's State - - and agree that, if I should be subje o th orker ompensa n provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or + 3/00 of the Labor Code, th com wit ose provi ' ns. 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).: ate:. plicant: (_ 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 WAR ING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND S Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). 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 Application is 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 upon 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 • 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. Date: Owner: 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 issua4ofWpermit,tion of work for 180 days will subject CONSTRUCTION LENDING AGENCY , permit to cancellation. hereby affirm under penalty of perjury-that there is a construction lending agency for the performance of the I certify that I have read this application and state is correct. I agree to compl w' work for which this permit is issued (Sec. 3097,, Civ. CJ. city and co ty ordinces and state laws relatinnd'here representatives of thiscou toe er upon th bove-mentionedposes. Lender's Name: t/qv� net re (Applicant or e Lender's Address: .. LQPERMIT s Application Number . . . . . 05-00001996 Permit . .. . . . WALL/FENCE•PERMIT Additional desc . Permit Fee 63.00 P1an'Check Fee .00 Issue Date . . Valuation . . 3075 Expiration Date_. .11/20/05 Qty Unit Charge Per Extension BASE FEE 45.00 2.00 9'.0000 THOU RTd1h 7., nni.-?q, nnn 18:00 Special. Notes and Comments 123 L.F. 6' GARDEN WALL, ORCO SYSTEM Fee summary Charged Paid ------------------------------------- 'Credited ---------- Due Permit Fee Total 63.00 .00 ---------- .00 63.00 Plan Check Total .00 .00. .00 .00 Grand,Total 63.00 .00 .00 63.00