07-2000 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation: .
C__0-7--
57767—SALIDA=DEL SOL
762-240-014-44 -34243'-
WALL/FENCE
RL AG/EQ OVERLAY
1691
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MADISON 58TH LA QUINTA,
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029
VOICE (760).777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/10/07.
LLC
Contractor:
Applicant: Architect or Engineer: INNOVATIVE COMMUNITES, -1/.4,
`200 E WASHINGTON 'AVE "S 10OC/j�.�
ESCONDIDO,, CA 92025
S J (760) 839-.8238
/�. Lic. No..:* 76318-7 �'. •_
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LICENSED CONTRACTOR'S DECLARATION- WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9,Icommencing with - I hereby affirm under,penalty of perjury one of .the following declarations:
Section 7000) of Division 3of the Business and Professionals Code, and my License is in fullforce and effect._; I have and will maintain a certificate of consentto self -insure for workers' compensation,';s`provided
UcenseClas;: B .License No 763187 for Section 3700 oftheLabor Code,+for the -performance of the work for which this permit is
�7 issued.; -
ate: tractor. - _,have and will maintain*workers' compensationinsurance, as required tiy.Section 3700 of the Labor .
7, Code, for the performance ofthework for which this permit is issued. My workers' compensation' .
q - OWNER-BUILDER,DECLARATION insurance carrier and policy number are:
_ I hereby.2ffirm under penalty of perjury that I arna empt from the,Contractor's.Sta£e License Law for the .. Carrier STATE •FUND. Policy Number.. 756000304 ....
following -reason (sec. 7031.5, Business and Professions Coder 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.thde' nworkers' compensation laws of California,
r permit to file,a signed statement that he or she.is licensed pursuant to th`e provisions of the Contractors State - • and agree that, if I should become subject to th-e,workers', compensation. provisions of Section '
License taw (Chapter 9 (commencing with Se6tion7000) of; Division 3,of the Business :and Professions:Code).or 3700 of the. Labor Code, I shall forthwith"comply witk.those provisions..' 5 . .
. that he or she is`,exempt,therefrom and .the basis for the alleged exemption.• Any violation of Section. 7031 .5 by
any applicant fora permit subjects theapplicant toa civil penalty. of. not more than five hundred dollars -(S 500).: 4 I-lat,' t , o'% plicant: '
( r)r I, as owner of.the�property, ormyemployees with wagesastheir sole compensation,..willdo the work, and • - '
the:structure �s: not intended or offered for sale lSec. 7044, Business and Professions Code. The WARNING: FAILURE TO SEC WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL.
Contractom`Siate License Law does not apply to an owner of property. who builds or, improves fhereon,• •SUBJECT AN, EMPLOYER TO�CRIMINALPENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and.who doesthe work himself or herself.,through his or hecownem'ployees, piovidedthat the DOLLARS ISt00;0001..IN'ADDITION TO THE�COST OF COIv1PENSATION,DAMAGES AS PROVIDED FOR IN
_ _�:
. - improvements are. not intended or off&ed 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 the -owner -builder will have the'burden'of proving that he or she did not build'or - -
improve for the purposeof solea. - APPLICANT ACKNOWLEDGEMENT ,
I, as ownerof the property,,amlexclusively ;contracting with licensed contractors to construct the project (Sec. IMPORTANT 'Application is. hereby made to the Diiector 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 conditionsand restrictions set forth on this application.
property who builds or improv"es 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—) 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 Quint;, its officers, agents and employees far any act or omission_ related to the work tieing.
- - 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
4 CONSTRUCTION LENDING AGENCY _ permit to cancellation. t
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 unty to enter. upon the above-mentioned property for inspection purposes.
Lender's Name: /� c,
gnatur
' re: � e (Applicant or Agent):
Lender's Address: -
LQPERMIT - ..y+�-•..
Application Number . . . . . 0.7-00002000
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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o •,..w.-- ,_ :�.-----�----------------------------.--------
Speci-al Notes3and•Comments
-------- _ ..
aV 69 LF 3L;4' WALL -& 6,9. LF 6'
.RETAINING
HIGH'WROUGHT IRON 'FENCE...
4t. Fee'summary• :Charged Paid Credited
Due
Permit Fee; Total• 39::0.0. 00 .00"
39.00.
P.16n,.,'Check., Total00 00 �.-00
00
Grarid,Total 39.00 .00 00
3.9.-00
LQPERMIT