04-3565 (BLCK)°F 4vQur«rw
P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number 04-00003565 Date 4/19/04
Property Address . . . . . 44155 CARMEN PL
APN: 604-151-002-13 -23269 -
Application description. WALL/FENCE
Property Zoning . . . . . . . •LOW DENSITY RESIDE A n
Application valuation . . 4825 [�
Owner Contractor APR 19 2004
MONEY MICHAEL D OWNER CITY OF LA QUINTA
44155 CARMEN PL FINANCE OEPT.
LA QUINTA. CA 92253
Permit . . . . . . WALL/FENCE PERMIT'
Additional desc
Permit Fee.. . . . . 72.00 Plan. Check Fee .00
Issue Date Valuation 4825
Qty Unit Charge Per Extension
BASE FEE 45.00
3.00 9.0000 THOU BLDG 2,001-25,000 27.00
---------------==-----------------------------------------------------------
Special Notes and Comments
193 LF 6' BLOCK WALL ALONG SIDE PROPERTY
LINES. 2001 CBC.
Fee summary Charged Paid Credited Due
Permit Fee Total. 72.00 .00 .00 72.00
Plan Check Total .00 .00 .00 .00
Grand Total 72.00 .00 .00 72.00
P.O. BOX 1504�� VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. d ' 3 J 6s Date: 0-Y
Applicant: oNG� Architect or Engineer.
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Applicant's Mailing Address: Architect or Engineer's Address:
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Lic. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby of rum under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing encing with Section 7000) of Division 3 of the Business and Plallssionds '
Code. and my license is in full force and effect
License Class License No.
Date • Corhtrador
OVDIER-BUILDER DECLARATION
1 hereby aftmm under penalty of perjury that I am exempt from the Contraclois• State License Low for the following reason (Sec. 7031.5. Business and Professions Code: Any
dly or county that tegtww a permit b construct alter. inhprove, demolish, or repair any structure. Prior to its issuance. also requires the applicant for to permit to fib a signed
statement that he or she is licensed pursuant to the provisions of the ComtracloW 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 ter Ma aRaged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
1Ne apoicant to a cavi penalty of not more than five hundred dollars (i500).):
I. as owner of the property, or my ernpbyees with wages as their sob compensation, will do the wok 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 o(prvperty who builds or improves theeon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not i ie ded or offered for sale. It. however. the building or improvement is
sold within one year of completion, to owrar-bilder will have the burden of proving that he or she did not build or improve for the Purpose at sak.)-
U t 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 appy to an owner of property who Milds or improves theieon, and who contracts for the projects with a contracto(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Data q owner
WORKERS' c TION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ 1 have and will maintain a certificate of consent to seffimsum for workers' compensation, as provided for by Section 3700 of the Labor Code, tot the peiforharhoe
of the work for which this pertNt is issued.
_ 1 have and will maintain workers' compensation insurance, as required by Section 3700 o(t a Labor code. for the performance of the work for vA id n this permit Is
issued. My workers' compensation insurance namer and policy number are:
Gamier Pawsy Number
I certify Mat, in the performance of the work for which Ccs permit is issued, l shall not employ any person in any manner so as to become subject to the workers'
corrpernsation taws cf California. and agree that ff i should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shad
iorffrNACu comply with Chose provisions.
pateL4 401 'l� Appfiwnt
WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS FUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO TFE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that Mara is a construction lending agency for the performance of am wok for which this permit is issued (Sec. 3097. Civ. C.).
Lenders Name V\41) t/\
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application Is hereby made to the Director c( Building and Safety for a permit subjeu i to the conditions and restrictions set forth on this application,
1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit
Issued as a ueshhit of this application, the owner. and the applicant, each agrees to. and shall. defend. indemnify and hold harniess the City of Le Oulnta. its
officers, agents and employees for any ad or omission related to the work being performed under or following issuance of this permit
2. Any peri issued as a result o(t is application becomes null and void If work is not cormhencod within 180 days from date of issuance of such perm) 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 erect 1 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 the above-mentioned property for inspection purposes.
Date l 1 Signature (Applicant or Agent):
4/
OWNER / BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as ''Owner/ Builder'' you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of variuus trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
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