05-3819 (BLCK)rte,
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: �05-0�0003819
Property Address: 5863'3'�QUARRY RANCH RD
APN: 766-060-999-9 -30651 -
Application description: WALL/FENCE
Property Zoning: JQkL DENSITY RESIDENTIAL
Application valuation: n 21A nIre .
Applicant: 1u I AUG 2,9
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LICENSED CONTRACTOR'S DECLARATION
•4
fG�ftiGV
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Professionals Code, and my License -is in full force and effect.
License Cela: License No.:
/Date: �T Contractor: C.i(9 (._J►.�/��t%C.i'10,J
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from -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).:
(_ I 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 _ 1 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 contractor(s) licensed
i yuiouenr w rhe i.unuet wib' .hate uuense LHW.1.
1 _ 1 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/29/05
Owner:
QUARRY, RANCH
41865 BOARDWALK NO 214.
PALM DESERT, CA 92211
Contractor:
C & G CONSTRUCTION COMPANY
WCC: STATE FUND
WC: 1799267 10/01/05
CSLB: 692234 07/31/06
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
Code, for the performance of the work for which this permit is issued. My workers' compensation
.insurance carrier and policy number are:
Carrier B Policy Number - - - - - - - - - - - ----
Icertify that, in the performance of the work for 'ch t 's permit is issued, I shall not employ any
person in any. manner soWdq
orkers' compensation laws of California,
and gree that, if I shoulrs' compensation provisions of Section
37 of the Labor Code,those provisions.
9 tge: dpplican�
WARNINFAIL RE 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 this aggligatign i5 mdd%-eerh nerson at whnsp. rrni nst and fnr
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 abov formation is ec agree to comply with all
city and cou y ordi nces and state laws relating to buildi. c structio ere uthorize representatives
of this cou 10-n u�on the above-mentioned prope or specti pur ses.
Date �• Signature (Applicant or Agent):
Application Number . . . . . 05-00003819
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee 15:00
Plan Check
Fee
.00
Issue Date
Valuation
272
Expiration Date 2/25/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
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Special Notes and Comments
10 L.F. 30" RETAINING WALL (COURTESY
INSPECTION); 5 L.F. 24" RETAINING WALL
(COURTESY INSPECTION); 17 L.F. 40"
RETAINING WALL, CITY STANDARD.
Fee summary Charged • Paid
-----------------'--------------------
Credited
----------
----------
Due
Permit.Fee Total 15.00
.00
.00
15.00
Plan Check Total .00
.00
.00
.00 "
Grand Total 15.00
.00
.00
15.00