04-7534 (BLCK)Ce
"Our 0BUILDING & SAFETY DEPARTMENT
Box 1504
(760) .777-7012
OF4'95 CALLS TAM'PICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7.153
BUILDING PERMIT
Application Number . . . . . 04-000075.34 Date 12/0.1/.04
Property Address . . . . . . 531360 DEL GATO DR
APN 770 -350 -017 -
Application description WALL/FENCE
Property Zoning . . . . - LOW DENSITY RESIDENTIAL
Application valuation 2950
Owner Contractor
AVERILL DAN L DRURY CONSTRUCTION
P O BOX 275 74634 CANDLEWOOD STREET
BIGFORK MN 59.911 PALM DESERT-. CA 92260
('76.0) 837-1025
WCC: STATE FUND.
WC: 1-57`69,04 12/01/04
CSLB: 42;94.3'1 12/31/04
CCC: B `
Permit. . . . . WALL/FENCE PERMIT
Additional desc . ..
Permit Fee, 54:00 Plan Check Fee .- .GO
Issue.Date . . Valuation . . . . 2950
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG 2,,001-'25, 00:0 9.00
Special Notes and Comments
118 LF S' RETAINING WITH 6'GARDEN WALL
PER APPROVED CALCS/PLAN. NOTE: RETAINING
CONDITION WITH BE EQUALIZED WHEN 53-330
DEL GAT.O IS BUILT.
Fee summary Charged
-----
Permit Fee Total 54.00
Plan Check Total .00
Grand Total 54.010
Paid Credited. Due
.00 .00 54.00
.00 .00 .0.0
00 -00 5'4 . 0,0
P.O. Box: 1504 VOICE (760) 777-7012
78-495 CALLS TAMPico FAX (760) 777-7011.
LA QILAt4VA, CALIFORNIA 9225344 INSPECTIONS (760) 777-7153
BUILDING & ,SA'FETY DEPARTMENT
Application Number: ��'- 7J 3'i" Date -12 �-
Applicant: GOlT71tre. I Architect or Engineer:
Applicant's Mailing,Address:
Architect or Engineer's Address:
Lic. No.:
BUILDING.PERMIT DECLARATIONS
LICENSED:CONTRACTOWS DECLARATION.
I hereby affirm under penalty of peduryithat I am licensed under provisions of Chapter,9.(commencing,with Section7000) of Division 3 of the:Business and Professionals
Code,,andimy,License is,inifull Jarce,and'effecL - Gi /
License Class b l Z se No. Z'!
Date J& 1-0Contractor
OWNER 3UILDER DECLARATION
I hereby affirm under penalty of perjury that'I am exempt from the Contractors' State License Lew for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or countythat requires a,permitto construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires tare applicant for the permit to fde a,signed
statement.that he or she is licensed pursuant to the provisions of the. Contractors' State License Law (Chapter 9,(commenang:with Section.7000) of Division 3.of.the Business
and Professions' Code)'or'that he or is exempt therefrom and the.basis for alleged exemption., Any violabon'of Section 7031 5b any applicant for a,permff subjects
the applicant.to.a,civil penalty of'not.mom than five hundred dollars ($500).):
(, I, is owner of the property; or.myemployees;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''StsWUcense Law does.notapply to an ownerof property who bullds,or improves therem,and who'does the work
himself or herself or through his or herown "employees, provided 'thabthe improvements are not intended or offered forsale: If; however, the building orimprovementis
sold .within one year of complefion, the owner -builder will have the burden of proving that he orshe did not build or improve for the purpose of sale:)..
U I, as owner of the property, am exclusivelycontracting with licensed contractors to,construct.the projecb(Sec. 7044j Ousiness and Professions Code: The Contractors'
State License Law does not+applyto an ownerof property who builds of, improves thereon, and who contracts for the projects with a contrector(s) licensed pursuant to
the Contractors',Stateticense Law.).
U I am exempt underSec., , BA PZ. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
hereby affmmunder penaltyof perjury one of thefollowing declarations:
_ I have and will maintain a -certificate of consent to self -insure for workers' compensation, asprovvded for by.Secfion 3700 of the labor Code, for the performance
of the work for which this permit, is issued.
X-- I have and will maintain workers' compensationiinsurance„as required by Section 3700 of the LaborCode;:for the performance of the work for which this permit, is
issued.. My.wgrrkers' compensation insurance carver an -d ppoliccyy numbb�ey�r'are:
Carrier Fr✓.✓� Policy Number
compensabon.laws o
forthwith comply with
WARNING:. FAILURE TO SECURE WORKEIi"COI
CIVIL FINES UP TO ONE HUNDRED THOUSAND D
SECTION 976f1 OF'THE LABOR CODE, INTEREST,.
thii permit is issued, I shall not employ any, person in any manner so as to becomwsubject to the workers`
I. should,become: subject to the workers' compeneation: provisions of Section 3706 of the Labor Code, I shelf
COVERAGE IS UNLAWFUL, AND SHALL; SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
I OODI, IN ADDITION TO THE COST OFCOMPENSATION,�DAMAGES AS PROVIDED FOR IN
CONSTRUCTION LENDING AGENCY
A hereby affirm under penalty of perjury thatithere is a constructionilending agencyfor the;. performance of the.work.for which this permit is issued(Sec. 3097; Civ. C,).
Lendees'Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a,pennit,subject.W:the conditions and'restrictions set forth onthls application.
1. 'Eech,person upon-whose.behalf this application is rade, each person at whose request and for whose benefit work4s, 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, Ind emnifyand .hold harmless' the City of La Ouinta, its
officers, agents and employees for any actor omission related to the work being performed underor foltowing Issuance of this permit:
2. Any permit issued as a result of this application becomes: null and 'void iif work is notcommenoed within 180 days from date of issuance of such permit, or
cessation,of:work for 180 days will su ijectpermitto cancellation:
I certify that, l have read:this application, and state that the above information' ls.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 enter bove-mentioned property for inspection purposes.
Date 1'1- f i L Signature (Applicant or Agent):