07-1992 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: r 07-00001992
Property Address:' 57764 SANTO THOMAS
APN: 762-240-014-33 -34243 -
Application description: WALL/FENCE '
Property Zoning: RL AG/EQ OVERLAY
Application valuation: 1691
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I 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.
Licensee Class: B License No.: 763187
' OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am 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 applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 70001 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 ($500).:
(_ 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. If, however, the building or improvement is sold within
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.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ ) I 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
Date: 7/10/07
Owner:
MADISON 58TH LA QUINTA, LLC
1282 PACIFIC OAKS PLACE
ESCONDIDO, CA 92029
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Contractor:
INNOVATIVE COMMUNITES, INC.
200 E. WASHINGTON AVE, STE#100
ESCONDIDO, CA 92025
(760)839-8238
Lic. No.: 763187
WORKER'S COMPENSATION DECLAR 710 J( �'
I hereby affirm under penalty of perjury one of the following declarations: V 171(//�//►�7
I have and will maintain a certificate of consent to self -insure for ork nsation, as pro'BiTfEd
for by Section 3700 of the Labor Code, for the performance f the worl[QLS4'0rftic it is
issued. o� VVQ
Yhave and will maintain workers' compensation insurance, as required by oto �� p�ya
Code, for the performance of the work for which this permit is issued. My workers Y on
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 manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
� 3700 of the Labor Code, hall forthwith comply ith those ose provisiOn3.
sd{e: '-' cant: �Ir` Jq1��
WARNING: FAILURE TO SECU ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF 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 arid 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 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 count to enter upon the above-mentioned property for inspection purposes.
/ C
9"a 07 S ature (Applicant or Agent): 1-2-1
1��, 1 4120--
Application Number 07-00001992
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
501-21000
24.00 .
-------------------------------------------------------
Special Notes and Comments
69 LF 314'- RETAINING WALL & 69 LF
61.
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
1.
Grand Total 39.00
..00
.00
39.00
LQFERMIT -
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