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06-0340 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: � -00000340 Applicant: Architect or Engineer: Property Address: 4"6075 ROADRUNNER LN APN: 649-040-007-3 -31816 Application description: WALL/FENCE Property Zoning: MEDIUM DENSITY RES Application valuation: 2500 ---------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I licensed u er pr ions of Chapter 9 (commencing with ' Section 7000) of Division 3 of the Bu ess a d Professio Is Co ,and my License is in full force and effect. Licen a Class: 13 Li se No.: 808912 r D e: trac OW UILD ECLARATION hereby affirm under penalty of perjury that I am e� pt 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).: (_ 1 1, as owner df the property, or my employees with wages as their sale 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, 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.). I—) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: BUILDING & SAFETY DEPARTMENT BUILDING. PERMIT 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: Owner: LA QUINTA NORTH PARTNERS 2 CROOKED STICK DR NEWPORT BEACH, CA 92660 ( - Contractor: URBAN HABITAT 2 CROOKED STICK DRIVE NEWPORT BEACH, CA 92660 (.949) 533-9408 Lic. No.: 808912 VOICE (760) 777-7012 FAX '(760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/23/06 LP 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. Y` I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code,cfor 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 f hich this permit is issued, 1 shall not employ any person in any manner so as to becomes t to a workers' compensation laws of California, and agree that, if I should. come sub' to workers' compensation provisions of Section �37/0y0 of the Lab C e, I hall fo th ply with those provisions. WARNING: FAILURE TO SECURE WORKERS' C PENSATION 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 fora 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 aresult of this application, the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinti, 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 f 180 days will subject permit to cancellation. I certify that I have read this application and state tVe information iorrec agree tocomply with all city and county ordinances and state laws relating t instruction, her uthorize representatives o�-countyr�terupo he above-mentioned nspecti as D e: v�/J /�� ignature (Applicant or „ter Application Number . . 06700000340 •- Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . 54.00 Plan Check Fee 00 Issue Date . . Valuation . . . . 2500 Expiration Date 7/22/06 Qty Unit Charge Per Extension BASE FEE 45.00 1.00 9: 0000 TIIOU DLDC3 2,001-25,000 9.00 ---------------------------------------------------------------------------- Special Notes and Comments' 100 L.F. 6' GARDEN WALL, ORCO SYSTEM Fee summary Charged Paid Credited Due Permit -Fee Total 54:00 .00 .00 54.00 Plan Check Total .00 .00 .00 .00 Grand Total 54.00 .00 .00 54.00 LQPERMIT .. _.