07-1965 (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:
07-00001965
57596 SANTO THOMAS
762-240-014-26 -34243
WALL/FENCE
RL AG/EQ OVERLAY
1691
Architect or Engineer:
P. per
4 VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/06/07
Owner:
MADISON 58TH LA QUINTA, LLC
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029
Contractor: D d
INNOVATIVE COMMUNITES, INC.
200 E. WASHINGTON AVE, STE#1 JUL 17 2007
ESCONDIDO, CA 92025
(760) 839-8238 C11"1'OF J
LiC. No.: 763187 FniulA �QVI�T4 1
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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 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 _ License No.: 1763187
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
1 - ^0 -
issued.
Date: G Contractor:
_ 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 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 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
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I hall forthwith comply it hose provisions.
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 ($500).:
�7
Date:.�iAPPlicant: f
(_ 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 ISec. 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 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 the
DOLLARS ($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 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 ..
(_) 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 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 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
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:
LQPE%NIIT
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 date of issuance of such permit, 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 county to ent r upon the above-mentioned property for inspection purposes.
Date: .' ignature (Applicant or Agent): _
Application Number 07-00001965
Permit WALL/FENCE
PERMIT
Additional desc .
Permit Fee 39.00
Plan Check
Fee
00
Issue Date . . . .
Valuation
1691
Expiration Date 1/02/08
Qty .Unit Charge Per
Extension
BASE
FEE
15.00
12.00 2.0000 HND BLDG
501-2,000
24.00
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Special Notes and Comments
69 LF 3:41% RETAING 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
LQPERDIIT