07-2003 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
n
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
LQPERMIT
Date: 7/10/07
Application Number: CO.7yQ0_0"0'2'003a
Owner:
Property Address: 57695 SALIDA DEL SOL
MADISON 58TH LA QUINTA, LLC
APN: 762-240-014-47 -34243 -
Application description: WALL/FENCE
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029 d
Property Zoning: RL AG/EQ OVERLAY
tJ
Q
Application valuation: 1691
;Contractor: JUL. 17
ZOOl ,
Applicant: Architect or Engineer:.
INNOVATIVE COMMUNITES _ INC.0
^
200 E. WASHINGTON AVE,. #1� OFLAQJJ
ESCONDIDO,''CA 92025
(760)839-8238
Lic_ No.: 763187.
/
' LICENSED CONTRACTOR'S -DECLARATION
WORKER'S COMPENSATION DECLARATION +
I.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 Division3'of the Business and. Professionals Code, and my 66ense is in full force and effect.
I have and will maintain a certificate of consentto self -insure for workers' compensation, as provided
- License-7Class:r B _ . License No.: 763.187 •• "•
_
- for by Section 3700 of _the Labor'Code, for the performance of the work for whichthis permit is
1
.!( ' [fes(// - e -
ate: O " ntractor:
-issued. ra , 0
- � .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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are: - ..
I hereby affirm under, penalty. of.perjurv.that I am exempt: from the ConEractor.'s State License Law for the
Carrier STATE FUND ' . " Policy Number 756000304.
following reason (Sec:';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
construct,'alter, improve demolish, or repaii any structure, prior"to'its issuance; also requires the applicant for the
person in•any manner so as.to become subject to the workers' 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 should become su6)6ct.to:the workers-compensaiion'provisions of Section
License La,w,(Chapter;8 (con encing with Section 70001f D
oivision3 of the Business and` Professions Code) or
3700 of the'. Labor Code, I shall forthwith comply :with those provision's.
'thattie.or she is exempt therefrorri andthe basis for the alleged exemption.' Any violation`of Secbon,7031 .5 by
any applicant for apermit subjects the applicant to a civil penalty ,of not more than five hundred dollais 155001.:
ate: 6? plicant: ..
• (_) 1, as ownerof the property, or. my employees with wages as their sole compensation, will do the work;.and
-
. the structure is not intended.oi offered for sale (Sec., 7044, Business and Professions, Code: The
WARNING: FAILURE TO SECU ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL . '.
' Contractors'. State: License Law does -not 1. apply to an of property who builds or. improves thereon,
SUBJECT,AN-.EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES'UP T07ONE HUNDRED THOUSAND
._and who does the work himself or herself through his or her ownemployees,_ 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 ATTORNEYS FEES. • ` 't'-'
- one year of completion, the ti vner-builder will have the burden of proving that he or she did�not build or; ,
...
improve for the purpose of sale.). - - _
- APPLICANT ACKNOWLEDGEMENT s
_J 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 setforth on this application.
property who builds or improves thereon, and who .contracts for the projects with a contractor(s) licensed
1. Eachperson upon whose behalf.this application is made, each person at whoserequestand 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 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
within 180 days from date of issuance ofsuchpermit, or cessation of work for 180 days will subject.
' CONSTRUCTION LENDING AGENCY
permit to cancellation. -
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of thi unt to enter upon the above-mentioned property for inspection purposes.
Lender's Name:
7
-
Date: 7 ° / nature (Applicant or Agent):
Lender's Address:
LQPERMIT
Application Number . . . . . 07-00002003
Permit WALL/FENCE PERMIT
"Additional desc .
Permit Fee . . . . 39.0.0. Plan Check Fee .00"
Issue Date . . . Valuation 1691
Expiration Date— 1/06/08
Qty. Unit Charge' Per Extension
BASE FEE 15.00
12.00 2.0'000 HND BLDG 501-21000 :24.00
Special-.Notes and Comments
69 LF ..3'1'4.1 RETAINING WALL &. 69 LF 6'
HIGIf-WROUGHT. IRON'- FENCE .
LQPERMIT -