05-2005 (BLCK)P.0: BOX. 1504 Td ^! + . VOICE (760) 777-7012
78-495 CALLE TAMPICO �" '�` : r,y'� `J� FAX (760) 777-7011
'r LA QUINTA, CALIFORNIA" 92253 • BUILDING & SAFETY DEPARTMENTINSPECTIONS (760) 777-7153
BUILDING PERMIT:T'
'. r '
•. , - 'C fW . 'irM Date. • 5/25/05•
Application Number. 5 00002005: ; ' '•~' '. <. Owner: "• f ;" `
Property Address: ' 803.55' OLD"RANCH ,TR S E ` ( '• , STONE CREEK •INC "
APN: 762-240"999-39 -30U4 `-� 80-355 OLD RANCH TRAIL SOUTH fK
Application description: - WALL/FENCE 1 ` - s O + ^ d 'LA QUINTA; CA 92253 ;
:•r- Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4557 " y, + �- -
.� &A .. Contractor l
s± 9ry
Applicant:. Architect or. Engineer. Cy M J & G MASONRY r - • -'
10226 VIREO CIRCLE
�/ygNCEo�V�aj� FOUNTAIN VALLEY, CA 92708 -
(7.60)343-6193
... • Li& No. 827707-
7
27707.
! y i � .�J � ., - a 1 � ^� F '' `. �` `- - - f '..r. . • ,• �'r f - " ��•' tr X, a ' - e r_V y.
lb
•
c
' LICENSED CONTRACTOR'S DECLARATION _ i i, •. 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:
r _ Section 70001 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: C29License No.: 827707 - - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is:
- ' - - issued.
S� "i - . • ..• - -
^ Date: ontractor: , • I have and will maintain workers' compensation insurance, as required by Section 3700 of -the Labor _
•`e�„ 1 + . , 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 STATE FUND - Policy Number ' 1769682
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 r�
,c� • 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, ,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State 1' '- and agree that, if I should become subject to the workers' compensation provisions of Section y
License Law (Chapter 9 (commencing with Section 7000) of Division of the Business and Professions Code) or', e. 3700 of the tabor Code, I shall forthwith 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"+^•-+-•e� /^� +r••--•.,,,•�_ .
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:, 1 Date: ;-�2-� Appli/ cant: ,
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and _ k-- �:
the structure is not intended or offered for sale (Sec: 7044,'Business and Profession s Code: The t WARNING: FAILURE TO SECURE WORKE OMPENSATION 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 ALTIES 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 PR OVIDED FOR IN
improvements are not intended or offered for sate. 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.). • • r _ * - - 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. - - , BAP.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 .
- - • within 180 days from date of issuance of such permit, or cessation of work for 180 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 agree to comply with all
work for which this permit is issued (Sec_. 3097, Civ. C.). ` " n ,f city and county ordinances and state laws relating to building construction, and hereby authorize representatives
_ y • - ,r - L - of this county to enter upon the above-mentioned property for inspection purposes.
Lender's Name.
" • e . • '' ;� � � Date: ��• Signature (APPlicant or Agentl:'�- - 1 '
• Lender's Address: • -=z✓ €'` -
LQPERMTT - s - • , ,`� r yr- •, ' •r ', ' - , T 'r. • - +
Application Number . . . . 05-00002005
Permit WALL/FENCE PERMIT -
Additional desc .
Permit Fee 72.00 Plan Check Fee
:°00
Issue Date Valuation . . .
. 4557
Expiration Date 11/21/05
r
Qty Unit Charge Per
Extension
" BASE FEE
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
- - ---------------------------------------------------------
Special Notes and Comments
} 100 LF 6' BLOCK WALL INTERIOR SIDE
YARD/95 LF 5' BLOCK WALL ALONG FRONT &
EXTERIOR SIDE YARD. ALL FOOTINGS PER
ORCO DETAIL -
- Fee summary Charged Paid Credited
Due
Permit Fee Total 72.00 .00 .00
72.00
Plan Check Total .00 .00 .00
.00
Grand Total 72.00 00 .00
72.00