07-2006 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,=CALIFORNIA 92253
Application Number:07�-00002-0"0"6
Property Address:. 57623 SAliI'DA DE SOL
APN: 762-240-014-50 -34243 -
Application description:. WALL/FENCE
Property•Zoning: RL AG/EQ OVERLAY
`Application .valuation: 1691
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VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT '
Date: 7/10/07
} . Owner:
MADISON 58TH LA QUINTA, LLC
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029
Applicant: Architect or Engineer:
'- -----
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 and Professionals Code,,and my License is infull force and effect.
License Class:'.B * " " " ..LicenseNo.:763187.:.
ate "-( '1 6.. ntractor:
OWNER-8UI LDEW DECLARATION
I hereby,affirin under "penalty of- perjury that Ram.exempt from.the Cowntractor's StateLicense'Lafor'the '
following reason ISec.,7031 .5,, Business and Professions Code: Any city or county that requires'a permit io
construct, alter, improve,.demolish, or repair any structure;,prior. to its issuance, also requires the applicant for the
•. permltto file a signed'statement that he or shels licensed pursuant'to the provisions of.the ContractoPs 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'exei»ption. Any violation of Section 7031.5 by
any applicant for a permit sublects:the.applicant to,a civil penalty of not more than five hundred dollars ($5001.:
(_ 1 I, as owner'of the property,';or my employees with wages"6s,thelrsole.compensatien, will'do the work, _and
the structure is not intended or offered for'sale ISec_ 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.workhimself: or herself'through'his or hecown employees, provided thaYthe
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 I, as owner of the property, am -exclusively contractingwith 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 theContractors' 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: VIA
LQPERMIT
Contractor:
INNOVATIVE COMMUNITES, INC.,
200 E. WASHINGTON AVE,.STE#1
ESCONDIDO, CA 92025
,(760).839=.8238
Lic. No.: 763.187
WORKER'S COMPENSATION DEI
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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. 1-
•I have and will maintain workers' compensation insurance, as required by Section'$700,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. `756000304•
_ I certify that, in the performance of -the work for which thispermitis issued.1 shall not employ any
'person' in any manner so as to becomesubject to the workers' compensation laws of California,
and agreethaG if 1 should become subject to the workers' compensation provisions of Section
37000 of the Labor Code, I"shall \rthwith comply with those provisions.
ate:' / i, Ica nt: --
WARNING: FAILURE TO SEC WORKERS' CONIPENSATION.COVERAGE 1S 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: - - - •
1. Each person upon whose behalf this applicationis 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 f 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 unty to enter upon the above-mentioned property for inspection purposes.
ate:�� gnature (Applicant or Agentl:
LQPERMIT .