06-0337 (BLCK)V-4 P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: L 06x_000.00337
Property Address:
46007 ROADRUNNER LN
APN:
649-040-007-1 -31816
Application description:
WALL/FENCE
Property Zoning:
MEDIUM DENSITY -RES
Application valuation:
2625
Applicant: Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
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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 an Professionalsde, and my License is in full force and effect.
Licens -lass: %B nse No.: 808912
Date/ / ntractor• '
.0fssions
UILDER DECLARATION -
I hereby affirm under penalty of perjury that I a rom the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and PCode: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair a 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 (5500).:
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and el
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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 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: 1/23/06
Owner:
LA QUINTA NORTH PARTNERS LP D
2.CROOKED STICK DR d
NEWPORT BEACH, CA 92660
(949)533-9408
Contractor:JAI r ,? 13 ®Q
URBAN HABITAT
2 CROOKED STICK DRIVE
NEWPORT BEACH, CA 92660CE®F��
(949)533-9408
Lic. No.: 808912
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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
X-1
' issued.
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 STATE FUND Policy Number 1741937-2005
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 a workers' compensation laws of California,
and agree that, if I shout econ subject tot orkers' compensation provisions of Section
3700 of the Lab de, shall forth h co y with those provisions.
i
WARNING: FAILURE TO SECURE WORK ' C EN N COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEN S AND CIVI NES UP TO ONE HUNDRED THOUSAND .
DOLLARS 15100,0001. 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 per/reby
f work'for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the abov act. I agree to comply with all
city and county ordinances and state laws relating to b '(ding y authorize representatives
ofth�i/; ounty toe er upon a above-mentioned pr e f in.
,a7
aid: �7� gnature (Applicant or Agen
J Application Number . . . 06-00000337
Permit . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 54.00 Plan Check Fee .00
Issue Date . . Valuation . . . . 2625
Expiration Date 7/22/06
Qty Unit Charge Per Extension
BASE FEE 45.00
i nn ?.0000 THOU --BLDG 2',001=25,000 9.00.
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Special Notes and Comments
105 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary ChargedPaid- Credited' Due
Permit Fee Total 54.00 .00 .00 54.00
Plan Check Total .00 .00 .00 .00.
Grand Total 54.00 .00 .0.0 54.00