06-2820 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
_ f
Application Number: C06-00002820.- i
Property Address: 46180 ROUDEL LN
APN: 649-040-007--13 -31816-
Application description: WALL/FENCE
Property Zoning: MEDIUM DENSITY RES
Application valuation: 2500
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
LA QUINTA NORTH PARTNERS LP
2 CROOKED STICK DR
NEWPORT BEACH, CA 92660
(949)533-9408
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: ' 7/27/06
' Contractor:
Applicant: Architect or Engineer: MCD CONSTRU L
49881 29 PAM760N363-774 Lic. No.: 8 8
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I a lic/undevisions of Chapter 9 (commencingwith I hereby affirm under penalty of perjury one of the following declarations:Section7000) of Division 3 of the Busi ss and ro, a my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as providedLicense' lass: B 820821 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
W*i.ntractor
issued.
a .• 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
OW ER-BUI ER DECLAR ON _ insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt f m the Contractor's State license Law for the Carrier STATE FUND Policy Number 0442271205
following reason (Sec. 7031.5, Business and Professions ode: Any city. or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I'shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to ecome subject to the orkers' compensation laws of California, -
permit to.file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I sho d bec a subject t he w ers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the L or C e, sh 1 forthwit ompl ith those provisions. '
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).: at -� plicant:,
(_) 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 WARNING: FAIL RE TO SECURE WORKERS' COMPEN ION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby,made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with.a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). _ whose benefit work is performed under or pursuant to any permit issued as a result of this application, ,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason - 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.
Date: Owner: 2. Any permit issued as a result of this application becomes null and void if work is not commenced
CONSTRUCTION LENDING AGENCY
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:
v
LQPERMIT
within 180 days from date of issuance of such permit, or cessation of work for 780 days will subject
permit to cancellation.
I certify that I have read this application and state that the abov information is correct. I agree to comply with all
city and c unty ordinances and state laws relating to bui ng c struction, anWhereby authorize representatives
of this unty to enter on eabove-mentioned prop t for ' spection p oses.
to nature (Applicant or Agentl:
Application Number
06-00002820
Permit
WALL/FENCE PERMIT
Additional desc .
Permit Fee . .
. 54.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 2500
Expiration Date
1/23/07
Qty Unit Charge
Per
Extension
BASE FEE
45.00
1.00 9.0000
THOU BLDG 2,001-25,000
9.00
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Special Notes and
Special
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Comments
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100 L.F. 6' GARDEN
WALL,.ORCO SYSTEM
Fee summary
Charged Paid
Credited
Due
Pc:mit Fee Total
54.00
.00
.00
54.00
Plan Check Total
.00
.00
.00
.00
Grand Total
54.00
.00
.00
54.00