08-0772 (BLCK)P.b. i3i3sY 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-00000772
Property Address: 50805 CEREZA
APN: 776-190-024-24 -32751 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 288
T4ht 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CITRUS EL DORADO LLC
1157 N RED GUM ST
ANAHEIM, CA 92806
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
D�J Contractor:
Applicant: Architect or Engineer: {A r� CRAFTSMEN HOMES- COMMNITIES INC
1157 N REDUM
O ` fy 2008 ANAHEIM, CAG92806
t
CITY OF (714) 630-7685
QUINTA LiC. No.: 828210
rJ FINANCE DEPT:
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am li nsed under provisions of Chapter 9 (commencing with
Section 700 1 of D'vision 3 of the Busin s a P fessionals Code, and my License is in full force and effect.
License C a s: C License No.: 828210
te: tractor:
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, 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.).
(_) 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
pursuant to the Contractors' State License Law.).
(_ 1
lam 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: rig
Lender's Address: ri
LQPERMTT
Date: 5/06/08
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.
VJ 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 DELOS INS CO Policy Number 01DKRM12003066
I certify that, in the performanje
thk
for which this permit is issued, I shall not employ any
person in any manner so acbject to the workers' compensation laws of California,
an agree that, if I sho e to the workers' compensation provisions of Section
�7 e Lab r Co , 1 ocomply with those provisions.
e: licant: '
WARNING: FAI URE 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 application is made, 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 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 statAthat e a 6nformation correct. I agree to comply with all
city and c my finances and state laws relatindi hereby authorize representatives
of this t t r upon the above-mentioneorses.
e: S' ature (Applicant or Age
Application Number . . 08-00000772
• Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 15.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 288
Expiration Date
11/02/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
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Special Notes and
Comments
18 L.F. 4' RETAINING WALL, APPROVED ORCO
SYSTEM
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
LQFERMIT