07-2001 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
0,7,E 00002001 -
Property Address:
57743"SALIDA DEL SOL
APN:
762-240-014-45 -34243.-
Application description:
. WALL/FENCE
Property Zoning:
RL AG/EQ OVERLAY
Application valuation:
1691
Applicant: Architect or Engineer:
4 QUM&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT.
Owner:
MADISON 58TH LA QUINTA,
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029 .
LLC
Contractor:
INNOVATIVE.COMMUNITES, INC..
200.E..WASHINGTON.AVE,• STE#
ESCONDIDO,- CA 92025
(760),839-8238'
Lic. No 763187
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/10/07
' LICENSED .CONTRACTO R'S DECLARATION
- WORKER'S COMPENSATION DECLARATION- -
I hereby affirm under penalty of perjury that I amlicensed 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 forceandeffect:
- I have and, will maintain a certificate of consent to self -insure for'workers' compensation, as provided
License CIa s. License No.: 76318.7
.
_
for ,by Section 3700 of the Labor Code,-for.the' performance of the work for which this permit is
..
ate: �� "t C •ractor'
issued.
.' ,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 DECLARATION111
insurance carrier and policy numberare:
. I hereby affirm under penalty of-perjury.that I am exempt from the Contractor'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 repair 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'signeostatement 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 ofSection
License Law..(CAapter 9'(comrnencing with Section 7000) of Division 3 of !the Business. and Professions Code) or
3700 of the Labor Code,a shall forthwith comply with those provisions. '.
that he or she is,ekempt therefrom and the basis alleged exemptions Any violatio' A'of Section 7031 :5 by
' any applicant fora permrtsubiects the applicant to a'civil penalty -of not more than five hundred dollars ($500).:
plicant: a
(_ 1 I; as owner ofthe property,'or' my' employe aswithwages as their sole compensation, will do the work, and
the.sfructure isnot intended or 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 apply to an owner of property who builds or improves the
SUBJECT AN EMPLOYER .TO) CRIMINAL PENALTIES AND'CIVIL FINES .UP.TO ONE HUNDREDTH OUSAND
. and who does the woW himself or herself through his or her own employees, provided that the.
DOLLARS ($100,0001. IN ADDITION TO THE COST OF COMPENSATION DAMAGES AS PROVIDED FOR IN
improvementsare not intended or offered for sale. If, however, the building orimprovement is sold within
SECTION 3706 OF THE.LABOR CODE; INTEREST, AND ATTORNEY'S FEES. -
one year of completion, the owner -builder will have theburden of proving that he or shedidnot build or . -
- '
improve'for the purpose of sale.)..
APPLICANT ACKNOWLEDGEMENT
(_ 1 1, as owner of the'pioperty, 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 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 Quints, 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 of such permit, 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 this c unt to a ter upon the above-mentioned property for inspection purposes.
Lender's Name:
9
e: 7 /7 nature (Applicant or Agentl:
Lender's Address:
LQPERMIT
. Application Number . . . . . 07-00002001
- 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
------------------------------ ••Special• Notes wand' Cominerits--------------------------------------------------------
-------------
�.. „ . ._
--an
.---.--------------------------
.• � - .
. 69 LF 314". RETAINING• -WALL & 69 LF
6'
HIGH - WROUGHT IRON -.,FENCE'.
- Fee`.summary :Charged-
=----`--''-------=--
Paid.; Credited
Due
-----------
Permit. Fee Total 39-0 .0
---------.---
A0
00
-----------
39.00•
Pla'7 Check Total .00
00"
.00
...00
Grand Total .39.00
.00
.00
39.00.
LQPERMIT