07-1999 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application. description
Property Zoning:
Application valuation:
Applicant:
07-00001999
57791 SALIDA DEL SOL
762-240-014-43 -34243
WALL/FENCE
RL AG/EQ OVERLAY
1691
. 4,. -
T4t�l
"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
P1lo
' LICENSED. CONTRACTOR'S DECLARATION
I he.reby_affirm under penalty of perjury that! 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: B License No.: 763187
ate: tractor:
�'
OWNER -BUILDER DECLARATION .
here by: affirm under penalty of perjury.that Tarim exempt from 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 -any structure;. prior to its issuance, also requires the applicantfor the -
permit to file a.signed statement that he or she is licensed pursuant.to the provisions of the Contractods. State' '
License Law (Chapter 9 (commencing with Section 7000) of,Division 3 of the Business and Professions Code) or
that he or she ,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 (5500).:
(_ 1 I, as owner of.the property, or my, employees with wages as their sole compensation, will do the work, and -�
the structure is not intended or offered for sale (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 does the work`himself:or herself through his or her own employees, provided that the .
improvements are not intended or offered for sale.4If, -however;the building or improvement is sold within
one year of conmpleiion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of safe.).
(_) I; as owner of the property, am exclusively. contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Coder The.Contractors' State License Law -does not apply to an owner of
property who builds or improves theieon,'and who contracts for the projects with a contractor(s) licensed
• pursuant to the Contractors' State License Law.).
( ) 1 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
MADISON 58TH LA QUINTA, LLC
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029
Contractor.
INNOVATIVE COMMUNITES, INC.
200 E.'WASHINGTON AVE, STE#100
ESCONDIDO, CA 92025
(760)-839-8238
Lic . No.: 763187
Date: 7/10/07
. WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I 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
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
insurance carrier and policy number are:
Carrier STATE .FUND Policy Number 756000304
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any,nianner so as,to become subject to the woikers' compensation laws of California,
and agree that; if I should become subject to the workers' compensation provisions of Section
3/7000 of;the Labor Code,' I shall forthwith comply with
those provisions. -
Oates -L A ant: / t'L -7 a./
/WARNING: FAIL lRE:TO SECU WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL'
SUBJECT=AN,EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100;000). IN ADDITION TO THE�COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 37066F 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 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 daie of issuance of sucWpermit, 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 cqunly. to enter upon the above-mentioned property fo inspection purposes.
te: 7 �l O ' azure (Applicant or Agent):
f
Application Number . . . . . 07-00001999
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 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
LQPERMIT