07-2045 (BLCK)01�1- _
P.O BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4. XP Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/13/07
Application Number: ..�:-0'7=0000'2-04-
Owner:
Property Address: 578157SALIDA DEL SOL
MADISON 58TH LA QUINTA, LLC
APN: 762-240-014-42 -34243 -
1282 PACIFIC OAKS PLACE
Application description: WALL/FENCE
Property Zoning: RL AG/EQ OVERLAY
ESCONDIDO, CA 92029 D d
Application valuation: 3816
Contractor: JUL. 172007
Applicant: Architect or Engineer:
INNOVATIVE COMMUNITIES, IN
200 E. WASHINGTON AVE, TE#10111 I0FLAQU11 rA
ESCONDIDO, CA 920.25
(760)839'-8238
LiC. No.: 763187
All
1-
'. LICENS_ED CONTRACTOR'S DECLARATION
WORKER'S CO M PENSATION' 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 Division 3 of the Business and Professionals Code, and:my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers'. compensation, as provided
License Class B ,. LL*nsello.: 763187 -
_
for by Section 3700 of the Labor Code, for the performance of the.work for which this permit is
ate: 6 C ctor:
issued. .. ... -
lk 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,perjury than am exempt from the Contractor's, State License Law for the
Carrier STATE'..FUND Policy Number 756.000304'
' following reason (Sec. -703,1.5, 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' compehsation'laiws 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 subject to the workers' compensation provisions of Section
Y License Law (Chapter -9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of .the LatSor Code, is all forthwith comply with those provisions.
that he orshe is exerrmpt.therefrpm and the basis forthe alleged exemption. Any violation of'Section 7031 :5. by
- -
any applicant for a permiisubjects the applicant to a civil penalty of not more than five. hundred dollars IS5001.:
ate: 4 Ap ant:
(_ 1 I, as owner of. the property,; or my;employee.s 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
WARNING: FAILU TE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
OS
Contractors'. State License Law does not apply to an owner of property who builds*or improves thereon,
SUBJECT AN EMPLOYER-TO.CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE, HUNDRED THOUSAND _
-
and'who'does.the work himself or herself:through'his or her,own employees, provided that ttie
DOLLARS (5100,000). iIN'ADDITION TO•THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
. _
improvements a. e'not.intended or offeredfor- sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE. LABOR CODE, INTEREST,•AND ATTORNEY'S -FEES.
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,).
APPLICANT ACKNOWLEDGEMENT
1—) 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 set forth on this application.,
property. who builds ovimproves 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 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 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
Lender's Name:
of this 7 to enter upon the ve-mentioned property for inspection purposes.
'
ate: 6 �Si ture (Applicant or Agent):
- Lender's Address:
LQPERMIT
Application Number . . . . . 07-00002045
Permit - . . . . . WALL/FENCE PERMIT
Additional desc .
Permit .Fee 63.00 Plan•Check
Fee
..00
Issue Date Valuation
. - .
. 3816
„
Expiration Date 1/09/08
Qty Unit Charge Per
Extension
BASE'-FEE
45.00
2.00 9.0000 THOU•., BLDG ,2,,001=25, 000 .,
18.0:0
-------------- --- ----------------------------------
Special 'Notes'-`and"'Comments"
-------
_
69-L 3:4 'RETAINING WALL,-69 L.F.
-
WROUGHT IRON FENCE.,'& 85•`L:F. 61 GARDEN
WALL, CITY ".STANDARD'„ "
Fee summary. Charged Paid.."° Credited
Due
Permit+: Fee •Total 63..00 .00
.00
63.00
Plan . Che`ck' Total 0'0" _AO
. 00'
00
_00
Grand .Total 63.'00 00
00
63'.00