05-1552 (BLCK)0
OF,
u�i�c�cv
BUILDING &: SAFETY DEPARTMENT
P.O. Bax 1504 (7,60).777-701.2
78-495 CALLE TAMPI'CO, FAX (760) 777-7011
LA Q,UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7;153
BUILDING PERMIT
Application NVA,.
Property AddrAPN: ZGS
Application descript1 .
Property Zoning �--- -
aTY DR CA dUINTl1
Application valuat ,N
0 00-0155.2
530 DEL GATO DR
0-290-0:03- -
DENSITY RESIDENTIAL
5775
Date 4/2'5/05
Owner Contractor
EARL MORLEY HUDSON CONSTRUC.T,ION, INC., K...P
78321 DEACON DR.WEST 77622 COUNTRY CLUB DR, S,TE M
LA QUINTA, CA 922:53 PALM DESERT, CA 9221:1
(7'60).345-5154
WCC: EXEMPT
WC:. EXEMPT 07/31/05
CSLB : 818121 03/31/07 .
CCC: B
P.O.. Box 1504 VOICE (760) 777 70:12
713-495 CALL£ TA`MPICO F -AX (760) 777-7611
LA QUINTA, CALIFOR141A :92253 INSPECTIONS. .(760) 777-7153
BUILDING &. SAFETY DEPARTMENT
Application Number: b S- I S S'2_ Date:
Applicant: I Architect or Engineer
Applicant's Mailing Address:
Architect or Engineer's Address:.
Lic.tNo:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATIQN;
[,hereby affirm under penalty of perjury that I'am.licensed under. provisions of Chapter 9 (ooirirrtencing,w*Sleclion 7000) of Division 3 of the Business.and Professionals
Code, and my Lice sin I fo and effect.
License Class .�{ License No.
���%Z.�
Date4/ 'r —
L Contractor.a.b5o'1 �� �[�JL
OWNER430ILDEWDECLARATION
I herebya r undegpenalty'of perjury, that I am exempt f rn the Contractors' St to License Law for thelollowing reason (Sec. 7031:5; Business and Professions Code: Any
city coun that requires a permit to construct; alter ,.im rove„ .
demolish,orreit an structure; prior to its issuance, also requires,the applicant for'ft permit to flea 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 Divisi6n`•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 7031.5byany applicant for a permit subjects
the applicant We civil penalty of not more thanfrve hundred dollars ($500););.
U I, as owner of thwproperty, or my employees, with;wages as theirsole compensation, will do the work. and the structure is notintended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractors' State License Law,does,notapply to an owner of property who builds`or improves thereon: and who does:the:work
himself or herself or through his orlher own, employees, provided that the the aremot,intended'or offered. for sale. IL however, the building or improvement is
sold within one year of completion, the ,owner -builder will have the burden of proving that he orshe did not build or improve for purpose, of sale.).
(_) I, as owner of the property.. am exclusively contracting 'with licensed contractors to construct the project (Sec. 7044, Business and. ProfessionsCode: The Contractors'
State.License Law. does not apply to an owner of propertywho;builds or improves,thereon..and who contractsdor the projects;with a contractor(s) licensed pursuant to
the Contractors' State License Law:).
U I am exempt underSec. , B.& P.C. for this reason
Date: •' Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm:under penalty of pegury'one of,the,following declarations:
I'have and will, maintain a.certificate ofconsent io;seli-insure(or workers'°compensation, as provided for'-bySection 3700 of thelLabor Code, for the performance
ofthe: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 permitlis
issued: M ,workers"compensation• irisurance,camer and policy number are:
.–farrier' �Ae{ie�Nuratre�
I certify that, in the performance'of the work`forwhich. this:permitis issued, I shallnotempVo anyperson "inany.manner so as to; become subject to the workers'
compensation laws of°California, and agreethat, if I should become subjectto'the workers° compensation provisions of Section3700 of the Labor Code, I shall
forthwith comply,with those provisions.
Date 464Z Applicant
WARNING: FAILURE TO SECURE.W ERS' CO PENSATION 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 COMP.ENSATION,,DAMAGES AS PROVIDED FOR IN
SECTION 3706r OF THE LABOR CODE, INTEREST, AND,ATTORNEY?S FEES.
CONSTRUCTION LENDING:AGENCY
1: hereby affirm under penalty -of pedury that there is a construction lending agency forthe performance' of the work for which this permit isissued (Sec. 3097, Civ. C.).
Lenders;Name
L' enders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to ,the, Director of, Building and Safety fora permit subject to the conditions: and restrictions set forth ;on this application.
I. Each person upon whose behalf this application is made, each_person atwhose req uest.and for whose benefit workJs performed`under or pursuantto,any permit
issuedes aresult 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 actor omission related to the;workteing performed under or following issuance of.this permit.
2. Anyper mit: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 dayswill subject permit to cancellation.
I certify thatl have read this application and state that the, above information i correct. I agreeto comply with.all city and county ordinances and.state laws relating to building
construction, and hereby authorizerepresentatives of this, county to enter up the bove ntioned property for inspection purposes:
Date Z� —Signature :(Applicantor Agent):
Application Numbez . . . . . 0'S-00001552
Permit . . . . . . WALL/FENCE PERMIT
Additional desc . .
'Permit Fee . . . . 81.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . .
. 5775
Expiration Date,. 10/22/05
Qty Unit Charge Per
Extension
BASE FEE
45.00
4.00 9.0000 THOU BLDG 2,001-25,0.0,0
36.00
Special Notes and Comments
89 LF 6' BLOCK WALL/142 LF COMBO 30"
RETAINING WALL WITH 6' GARDEN WALL ON
TOP.ALL WALLS PER ORCO STANDARD
Fee. summary Charged Paid,
Credited
Due
Permit Fee Total 8.:1.00
.00 .00
81. 0'A
Plan Check Total .00
.00 .00
.00
Grand Total 81.00
.,OD .0)0
8;1.00
i
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