07-0921 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:07000009:21
Property Address:'7-9255—ROSE—DAWN
APN:
649-030-069-149 -31311 -
Application description:
WALL/FENCE
Property Zoning:
HIGH DENSITY RESIDENTIAL
Application valuation:
736
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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.
license Class: B C29 License No.: 820821
Date: Contractor:
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.l.
(�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 vM6 buMo -5 il... .... I uIld 11110 6u 60ua tui LIM P1Uje1.t3 vvldi a LUUUaLLUI(s) iiuUMM
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
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:
R.
LQPERMIT
I
)
VOICE (760) 777-7012
FAX (760) 777-7011 '
INSPECTIONS' (760) 777-7153
Date: 3/28/07
Owner:
SANTA ROSA DEVELOPMENT INC
46753 ADAMS ST
LA QUINTA, CA 92253
( D
Contractor: APR 0 5 2007
MCD CONSTRUCTION
49881.29 PALMS HIGHWAYI
MORONGO VALLEY, CA 922 6 CIT ®FLA01,1111dTA
MOlt
(760)363-7740
Lic. No.: 820821
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.
_ I 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 ST TE FUND Policy Number 0442271205
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
700 of the Labor e, I shall forthwith comply with those provisions.
e:cant:
i'
WARNING: FAIL RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT. AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. 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. '
I . eauli person upon wnose Denali tnls applleati6i) it diode, 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 state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this cou ty to enter upon the above-mentioned proper for insection purposes.
e. Sig re (Applicant or Agent)i
-P*.
Application Number. 07:00000921
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 21.00
Plan Check
Fee
.00
Issue Date . . .
Valuation
736
Expiration Date 9/24/07
Qty Unit Charge 'Per
Extension
BASE FEE
.15.00
-3.00 2.0000 HND BLDG -501-2,000
6.00
Special Notes and Comments
46 L.F. 4' PATIO/GARDEN-WALL, CITY
STANDARD
Fee summary Charged Paid
Credited
Due
Permit Fee Total 21.00
.0.0
.00
21.00
Plan Check Total .00
.00
.00
.00
Grand Total 21.00
.00
.00
21.00
LQPERMIT