07-2004 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 0_7700'0"0'20'0.4�-7--3.
Property Address: 57671 SALIDA DEL SOL
APN: 762-240-014-48 -34243 -
Application description: WALL/FENCE
Property Zoning: RL-AG/EQ OVERLAY
Application valuation: 1691
"`&t!t 4 4 Q"
Applicant: Architect or Engineer
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
.1 hi reby affirm under penalty ofperjury 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:- I3` '• License No.: 763187
wate. tractor:
.. Oz
OWNER-BUILDER DECLARATION
I hereby,affirm under penalty of perjury that I am exempt frd"m-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 anyatructure,.prior to'itsissuance; also requires the applicant.for the
permitao,file a signed statement that he or she is'licensed pursuant to the provisions of the Contractor's State
_License Law IChapter,9 (commencing with Section.7000) of Division3 of the Business and Professions,Code) or
o6t he or she is exempt therefrom and the basis for the alleged' axemption. Any violation of Section' 7031.5 by '
any applicant for a permit subjects the applicant to a•civil penalty of notmore than five hundred dollars ($500).:
(_ I I, as owner of the,property, or, my employees witfi wages as their sole compensation, will do the work, and
the structure is hot intended or offered for sale (Sec. 7044, Business and Professions Coder 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, asowner 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.).
1 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:
LQPERMIT
Owner:
MADISON 58TH LA QUINTA, LLC
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029
Contractor:
INNOVATIVE COMMUNITES; INC.'
200 E. WASHINGTON'AVE, ST_E_#1
ESCONDIDO, CA 92025
(760)839-8238
Lic. No.: 763187
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
sio
Date: 7/10/07
IJUL 17 2007
L FEM CE DEPT
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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
/1 .issued.'
I have and will maintain'workers' compensation insurance,.as required by Section 3700 of the Labor.
7- Code, for -the performance of the work for whichthis-permit is issued. My workers' "compensation
insurance carrier and policy number are: '
Carrier STATE. FUND', . 'Policy;Number ' 756000304
I certifythat,' 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
3700 of theLabor Code, I shall forthwith.comply with those provisions.
ate: _ Plicant:
WARNING: FAILURE TO SEC, 'WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES:UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,000). INADDITION 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'application is 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 funder 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 y to enter upon the above-mentioned property for inspection purposes.
at r/ C ,gnature (Applicant or Agen[��� e-]�� _
Application Number 07-00002004
Permit . . . WALL/FENCE PERMIT
.
Additional desc . .
Permit.Fee -39.00
Plan Check
Fee
.00•
Issue Date . . . .
Valuation
1691
Expiration Date 1/06/0.8
Qty 'Unit Charge Per
Extension
BASE
FEE
15.00
12.00 2.0000 HND BLDG
501=2,000
24.00
-------------------- 7t ---------------------
Notes• and --Comments =
Not-es .
-------------------------------
----------------------------------
69 : LF 3:4� RETAINING 'WALL & 69 LF
6'
HIGH WROUGHT IRON FENCE. �-
' Fee ,.summary ' Charged'_
Paid ". Credited
. _ ..
Due.,
-------------------
_ _ 'Permit Fee Total. 39.00
.0-0-,
'.00
39..00
- Plan Check Total:. 00
00
:00
00
Grand'. Total 3'9.00
.00
.00
39.00
LQPERMIT '