Loading...
07-1991 (BLCK)4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT � BUILDING PERMIT Application Number: c07-00-0-0-1 99.1 Owner: Property Address: 5774SANTO THOMAS MADISON 58TH LA QUINTA, LLC APN: 762-240-014-32 -34243 - 1282 PACIFIC OAKS PLACE Application description: WALL/FENCE ESCONDIDO, CA 92029 Property Zoning: RL 'AG./EQ OVERLAY Application valuation: 1691 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/10/07 Contractor: Applicant: Architect or Engineer: INNOVATIVE COMMUNITES, ,I 200 E. WASHINGTON. AVE, 100 0 ESCONDIDO, CA 92025 1 ( 760) 839-8238 Lic . No.: 763187 JUL . l'( 7 007 --- c�pF u► qulHr� ---------------------- 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 Clas B Lice No.:. 763187' - for by Section 3700 of the Labor Code, for the.performance of the work for which this -permit is issued. ate: ,l? tractor. ' 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 Karim exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 756000304 following 'raason,(Sec. 7031 .5, Business and Professions Code: Anycity 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, perinit'to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if 1 should become subject tothe workers' compensation provisions of Section License Law (Chapter 9 (commencing t hwith Section: 7600) of Division 3 of. the Business and Professions Code) or 3700. of the Labor Code, I shall forthwith comply _ th th a provisions. ' thae. or she is exempt therefrom and the basis for the. alleged exemption. Any violationof Section 7031.5 by any applicant for a.permit subjects the applicant to acivil,penalty of not more than five hundred dollars ($500).: Ap ant: 1 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 WARNING: FAILURE TO SECURE WORKERS' 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, providedthat the DOLLARS ($100,000). IN ADDITION T0, 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 dill 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 theproject(Sec. ' IMPORTANT Applicationis 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 ari 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 ofthis application,' 1 _ 1 I am exempt under Sec. , BAP.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: LQPERN11T 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 th nt ' 7o enter upon the above-mentioned property for inspection purposes. (Applicant or Agent): Application Number . . . . . 07-00001991 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 Comment°s 69 LF.314�1 RETAINING -WALL & 69 LF 6.1' HIGHWROUGHT IRON FENCE. Fee summary Charged. Paid Credited Due '. Permit Fee, Total.: '39.00 .00 .0,0. 39.00 . 'Plan,Check Total .00 ..00. .00 .00 GrandTotal 39.00' .00 0.0 :39..0.0.. LQPERMIT .