06-3470 (BLCK)p -P.O. BOX 1504 VOICE (760) 777-7012
.'*fir "78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 .
BUILDING PERMIT
Date: 9/27/06
Application. Number: 06-00003470 Owner:
Property Address: ' 52618. PALAZO' TAYLOR WOODROW HOMES, INC
APN: 767-200-011-50 318742- 15 CUSHING
Application description: WALL/FENCE IRVINE, CA 92618 .
Property Zoning: LOW DENSITY RESIDENTIAL. -
_Application valuation: 2875 a
e
Contractor:
Applicant: Architect or Engineer: TAYLOR WOODROW HOMES I 7-
(949)341-1200
16745 W. BERNARDO DR, E 1400!`[ SAN DIEGO, CA 92127, CO� LA 43UIPlTA
Lic. No.: 352047 CIF ANCE0E \
LICENSED CONTRACTOR'S DECLARATION - - 'WORKER'S COMPENSATION DECLARATION -
hereby affirm under penalty of perjury that 1 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.: 352047 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
,( tt�issued.
ate: w ontractor: / 0/l. '�C/� 1 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: `
hereby affirm under penalty of perjury that I am exempt from the Contractor's -State License Law for the Carrier LIBERTY MUTUAL Policy Number WA765D283614056
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, 1
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 su j 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 700of-the Labor Code, I shall for wi 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 �)-
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: -86te: ✓ �G 0� 'cant: -
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 herown 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
(_ 1 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,-
(_ ), 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 ofthisapplication becomes null and void if work is not commenced
_ within 180 days from date of issuance of such permit, or cessation of workfor 80 days will subject '
CONSTRUCTION LENDING AGENCY permit to cancellation. "
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application, and state that the above information is correct. I ree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, an hereby a prize r pr se atives
of this cou y to nter upon the above-mentioned propert .,W ection pur us�es.//S
' Lender's Name: � // ! � ��/
10. Y ate?! (� ,,nature (Applicant or Agent):
Lender's Address:
LQPERD4IT
Application,Number : .''06-00003470
Permit . . . WALL/FENCE PERMIT.
Additional desc .
Permit Fee 54.00•
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 2875
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
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Special Notes and Comments
115 L.F. 516" GARDEN WALL, PROTO
II
SYSTEM
. 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