05-2013 (BLCK)P
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253. BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
(,gApplicafio'n Number.��05=000020.1'3
Property Address:
APN:
58681 QUARRY RANCH RD
Application description:
766-060-999-12 -30651
Property Zoning:
WALL/FENCE
Application valuation:
LOW DENSIT
Applicant:
Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
---------------------------------
QUARRY RANCH
41865 BOARDWALK NO 214
Di9 PALM DESERT, CA 92211
i
MAY 2 F 2005 Contractor:
CITY AFlJ1AUINTA C & G CONSTRUCTION COMPANY
FINANCE DEPT 965 N. 2ND STREET
UPLAND, CA 91786
Lic. No.: 1799267
--,------------------------------------------------
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 Professionals Code, and my License is in full force and effect.
Licen;41a�sss:1692234 License No.: 1799267
ate: --�I
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 1$500).:
(_ 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
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 ofsale.). '
(_ 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
J•6, s.I'i '.rho builds ar imprwaa thenen, and ::.hc oantrgvty for thQ p.QjQQfr. —ith n rnmr—mr(cl lirancQrl
pursuant to the Contractors' State License Law.).
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
Date: 5/26/05
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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, forthe performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier 4567 Policy Number STATE FUND
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 to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labo C de, I shall f rthwith comply with those provisions.
ate: 5Zf.�� ;cant: � � _
WARNING: FAILURE 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 Farh nPrsnn Ilnnn whose. hehalf this aoollcatign IS fnade, 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 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.
I 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 st aws relating to building construction, and hereby authorize representatives
of this cco' nt� upon t above-mentioned prope for ir1>kp/Gctiooposes. _
(late: J u0 �gnature (Applicant or Agent): ►1Vf'
Application Number 05-00002013
`
Permit WALL/FENCE PERMIT
Additional desc .
-. Permit Fee* 21.00 Plan Check
Fee
00
Issue.Date• . . . . Valuation
750
Expiration Date 11/22/05
Qty Unit Charge Per
Extension
BASE FEE
15.00"
3.00 2.0000 HND BLDG 501-2,000.1
6.00
Special Notes and Comments
30 L.F."6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged 'Paid Credited
--------------------------- --- _--- -- ---------17- ----------
Due
Permit Fee Total 21.00 .00
.00
21.00
Plan Check Total .00 .00
.00
.00
Grand Total 21.`00 .00-
.00
21.00
'
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