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05-4479 (BLCK)1„1 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT �05!0_oA.0-4444.7.9 Date: 10/05/05 Application Number: Owner: Property Address: 78740 SANITA DR MYERS SHAUN M APN: 604-172-004-99 -23269 - 78-740 SANITA DR - Application description: WALL/FENCE LA QUINTA, -CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation_ : 1440 Contractor: Applicant: Architect or Engineer FEDOR MASONRY, JAMES 4) P.O. BOX 1397 SS LA QUINTA, CA 92247 (760)772.-3036. Li c. No.: 823181 OV ,o���� — ----———————————————————— — — — — -- ---- r — — — — — — —- zgLICENSED CONTRACTOR'S DECLA I. hereby.affirm'.under penalty of perjury that tem licensed under .provisionswof.Chap mm cing,' h Section 7000).of Division 3.of the Business and Professionals Code, and my License is, 11 force -an ffect. LicenseClass: C29 License No.: 823181 �«a Date`d 4 - O,IrCoP' nt— racto�r - OWNER -BUILDER DECLARATION I hereby affirm under penalty o rjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031. , 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 Icominencing 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 dpllars ($500).: ( _') 1, 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'.tiuilds or improves thereon, and who does the work hirnself or herself through his or her own'employeesrprovided that the improvements are not intended or offered for sale..lf; however, the building or improvementis sold within one yearof 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 1, 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 propertywho builds or improves thereon, and"who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (_ 1 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 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 permi6s issued. - . . _ I have and will maintain workers' compensation insurance, as required by Section 3.700 of the Labor Code, for the performance of the work for which this permit is issued. Myke o nsation insuia�j�,e carrier and.policy number are: prr?I)ee Carrier 1k%.94614.Az•r rtAN.jWA"Iicy Number -FQ� 12-4 - � 1 411-- 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. agreethat; if I should become subject to the workers' compensation provisions of Section 3700 of the Labor C d shall forthw' comply with those provisions. D.te--/U.•O -01 APpl�r l WARNING: FAILURE TO SE E WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($.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 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 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 informationis correct. 1 agree to comply with all city and county ordinances and state laws relating to buildin construction, and hereby authorize representatives of this county to enter upon the above-mentioned props for spection purposes. —Daf_/6'06.6J_ sr�.l� nt or Agent): IAP Application Number . . . . . 05-00004479 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . 35.00 Plan Check Fee .00' Issue Date . . . . Valuation 1440 Expiration'Date 4/03/06 Qty Unit Charge Per Extension BASE FEE 15.00 10:00 2.0000 HIND BLDG 501-2,000 20.00 ---------------------------------------------------------------------------- Special Notes and Comments 90 LF 4' RETAINING WALL PER ORCO STANDARD IN REAR YARD, WELL INSIDE PROPERTY LINE AND EXISTING REAR 6' WALL & EXISTING 61 -WOOD FENCE Q SIDE YARD Fee summary Charged Paid Credited Due ----------------------------------------------- Permit Fee Total 35.00 .00 ---------- .00 35.00 Plan Check Total .00 .00 .0-0 .00 Grand Total 35.00 .00 .00 35.00 LQPERMIT 11 CI DEPT. BUILDING & SAFE AP�Rov�D fOR CONSTRUCTI EXIs-rlrjG C.-,000 V e rvc ,:, , RE -INSPECTION FEE 0 1VED 01 StCN��CEO IF THE CARID 111 t NO EXqPTI�NS�.