06-3469 (BLCK)I
P.O. BOX 1504
78-495 CALLE TAMPICO '
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoninq: ``
Application valuation:
Applicant:
';::�06-00003469
52646 PALAZO
767-.200-011-49 -3187427
WALL/FENCE
LOW DENSITY RESIDENTIAL
2625
Architect or Engineer;
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N 1K
4
BUILDING & SAFETY DEPARTMENT.
BUILDING PERMIT!
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/27/06
Owner:
TAYLOR WOODROW HOMES, INC
15 CUSHING
IRVINE, CA 92618
Contractor:OCT 1 o 2006
TAYLOR WOODROW HOMES IN
16745 W. BERNARDO DR, S E r CI'� OF 1,A QUINTA -
SAN DIEGO, CA 92127 PI�AQdCEDEiaT
(949)341-1200
Lic. No.: 352047 .
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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.
_ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License s% B License No.: 352047
for by Section 3700 of the Labor Code, for the performance of the work for which this permit. is
issued.
v/ ontractor: K.ei(j //,41
V' I have and will maintain workers' compensation insuiance, as required. by Section 3700 of the labor '
ate: (f/L/.dOW
Code, for the performance of the work for which this permit is issued. My workers' compensation c
' - 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 LIBERTY MUTUAL Policy Number' WA76SD283614056
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in theperformance 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, I ,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State-
_ a d agree that, if I should become su to the workers' compensation provisions of Section
W
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
0 of the Labor Code, I II fo h comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
p .
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: scant: ,
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' OMPENSATIONCOVERAGE IS UNLAWFUL, AND SHALL e
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
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
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within 180 days from date of issuance of such permit, or cessation of work for 18 ys will subject
- CONSTRUCTION LENDING AGENCY
permit to cancellation.
Ihereby affirm under penalty of perjury that there is a construction lending agency for the performance of f the
I certify that I have read this application and state that the above information is rrect. 1 r to comp with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and count or 'nances and state laws relating to building construction, an ereby t ize repr atives
Lender's Name:
oft ' cgµPt� ter upon the above-mentioned prope or i spection pur oses
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Date: nature (Applicant or Agent):
V1-
Lender's Address: 1
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LQPER111IT
Application.Number . . ... . 06-0.0003469
.
Permit WALL/FENCE PERMIT
' Additional desc
-"-
Permit Fee 54.00
Plan Check Fee
.00
Issue Date
Valuation
2625
Expiration Date 3/26/07
Qty Unit Charge Per
_
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG"2,001-25,000
9.00.
-------------------=-----------'---------------------------------------------
Special Notes and Comments
105 L.F. 516" GARDEN WALL, PROTO
II
SYSTEM
P Fee summary Charged
Paid
Credited
Due
----------------- ---------- ---
------
---------- -----=----
Permit Fee Total 54_.00•
.00 .00
54.00
Plan Check Total :00
.00 .00
.00
Grand Total 54.00
.00 .00
54.00
J
- 'LQPERMIT -