07-2005 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07..=0'0002005
Property Address:
5`76477 SALIDA DEL SOL
APN:
762-240-014-49 -34243
.Application description:
WALL/FENCE
Property Zoning:
RL AG/EQ OVERLAY
Application valuation.
1691
Applicant:
Architect or Engineer:
�/A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/10/07
Owner:
MADISON 58TH LA QUINTA, LLC
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029
Contractor:
INNOVATIVE COMMUNITE NC:J00' 17 2007 1001
200 E. WASHINGTON AV TE#1 /
ESCONDIDO, CA .92025 CITY8F.1"
(760)839-8238• QUINTA
Lic - � No.: 763187 PI CE0EPT."
--------------------.=----- ----------------------------------
' -LICENSED CONTRACTOR'S DECLARATION
--- -------------------------=-----------
WORKER'S .COMPENSATION DECLARATION .
hereby affirm under penalty of perjury that I am licensed under provisions of. Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: "
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class:, •13 .– License No' 763187
for by Section -3700, of the Labor Code; for the performance of the work for which this permit is
'
te: �. 67 C . actor:I
issued.
have and will, maintain workers' compensation insurance, as required by Section 3700 of the Labor
- •. r
- ' --BUILDER
Code, for the performance of the work for which'this permit is issued. My workers' compensation
,i, i`• OWNER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
insurance carrier and policy number are:
Carrier STATE FUND. Policy Number 756000304.
following reason 1Se6..7031 :5, Business and Professions Code: 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
construe, alter, improve, demolish, or repair any structure, prior.to its issuance, also requires theapplicantfor the
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file.i signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
- and agree -that, if I should become subject to the workers' compensation provisions of Section
'I
License Law (6apter9 (commencing with Section 7000) of Divisi6n3 of the Business and Professions,Code) or
3700 of the Labor Code,shall forthwith comply with those provisions. -
.that he or sfie-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).:
ate: J / Iv/ licant: I
(_ 1 1, as owner of the property, or my employees:with wages as their sole compensation, will do:the work, and
r�
`. ' • —
"
the structure.is not intended or"offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TOSECU WORKERS' COMPENSATION COVERAGE'1S 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 AND CIVIL FINESUP TO ONE HUNDRED THOUSAND '
. and who does the work himself or herself'through'his or her own employees, provided that the
DOLLARS 1$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
1—) 1, 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,
(_) 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
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: rT
LQPERMIT
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 1 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 coun�r upon the above-mentioned prope for inspAiction purposes.
atPl e: �' ture'(Applicant or Agent� 1
ao.
LQPERMIT
Application Number . . . . . 07-00002005
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee 39.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 1691
Expiration Date 1/06/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00
12.00 2.0000 HND BLDG
501-2,000
24.00
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Special Notes and Comments
69 LF 3:4' RETAINING WALL & 69 LF
6'
HIGH WROUGHT IRON FENCE.
Fee summary Charged
Paid Credited
Due
----------
----------
----------
Permit Fee Total 39.00
.00
.00-
39.00
Plan Check Total .00
.00
.00
.00
Grand Total 39.00
.00
.00
39.00