04-7848 (BLCK).mow BCDA DEP ENT
9�yw� P.O. Box 1504 (` 60).7 012
`OFTt 78-495 CALLE TAMPICO AX�(%7,6,U1) 7 011
LA QUINTA, CALIFORNIA 92253 INSRECTIS�S (7.60 -7 53
�.ApU\Wt6sBUILDING PERMIT OF oEPIhA�0E
Application Number . . ..04-00007848 Date 12/16/04
Property Address 5=0505 ORCHARD LN1
APN:7"72-050-014- - -
.Application description WALL/FENCE
Property Zoning . . . LOW.DENSITY RESIDENT=AL
Application valuation 10.000
Owner Contractor
LA QUINTA ORCHARD.PARTNERS SPARKS CONSTRUCTION,. INC
P.O ..BOX 17.16 P.O. BOX 1716
LA QUINTA. CA, 92247 LA QUINTA CA 92247
.(76.0) 771-1941
WCC: STATE FUND
WC: 4610000348 01/01/05
CSLB:, 6740.4 07/31/05
CCC: B
Permit* WALL/FENCE PERMIT
Additional desc..
Permit Fee 117..00. Plan Check Fee .00
Issue Date Valuation 10000
Qty .Unit Charge Per Extension
BASE FEE 45.'00
8.00 9.0000 THOU -BLDG 2,001-25,000 72.00
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Special Notes and Comments
400 LF OF 6' BLOCK WALL OF WHICH 165 IS
COMBO 3' RET/6' GARDEN PER CDD APPROVED,
PLAN PER CITY "STANDARD.
Fee summary Charged Paid Credited Due
Permit Fee Total " '117.00 :00 CO 117.00
Plan Check Total .00 .00 C0 .00.,
Grand Total 117.00 .00 CO 117.00
P.O. BOX 1504
78-495 CALLS TAMPICO � VOICE (760) 777-7012
LA Qu1NTA, CALIFORNIA 92253 FAX (760) 777-7011INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: OY— 79VY Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Eng" per's Address:
Lic. No.:
MUILUINU HERMIT DECLARATIONS
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 Licens .s� ipp full forceand effect. / �7
',License Class ` 10 7 License No.t� 7 O
Date12Z G Contractor
OWNER -BUILDER DE .ARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' State License Law (Chapter 9 (commencing 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 dollars ($500).):
U 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 or 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.).
U 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 property who builds or improves thereon, and who. contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U 1 am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' 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 permit is issued.
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 insurance carrier nd policy number are:
--Carrier '4'Z t _ lw v D Policy Number - V & 1' O rp d 0 3 -F s-�
I certify that, in the performance of the work for which this permit is issued, I shall not emp—loy any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should a subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions
C =.Date L Z Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPS TION COVERAGE IS UNLA UL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION T THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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
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 flays 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 county to e�nthe erty for inspection purposes.
Date % -Signature (Applicant or Agent):