04-4516 (BLCK)/A`^\
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BUILDING & SAFETY DEPARTMENT
GPF�Odi$to�� (760).777-7012
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c�atOF 78-495 CALLS TA. ICO . FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS. (760) 777-7153
BUILDING PERMIT
Application Number
04-000045.16 __. Date .5/24/04
Property. Address
77255 CALLE NOGALES
APN:
773 -311 -001726 -000000 -
Application description . .
WALL/FENCE
Property Zoning . . .
COVE RESIDENTIAL
Application valuation
2`250
Owner
Contractor
ATWOOD LEON A
---.-----.:---------------=
AJF CONSTRUCTION .
77255 CALLE NOGALES
P.O. BOX 57724'
P 0 BOX 1167
SHERMAN.OAKS
CA 91413
LA QUINTA CA 92253.
(760) 641=5988
WCC: STATE FUND
WC: 13.711632003.
-10/01/04
-
CSLB: 787537'
11%03/04
CCC: B
------------
PermitWALL/FENCE
------------------------
PERMIT
-------------
Additional desc
Permit Fee . . . . 54.00
Plan Check Fee
00
Issue Date
Valuation
2250
Qty. Unit. Charge
.,Per
Extension
BASE FEE
1.00 9.0000 THOU BLDG.2,001-25,006
45..00,'
--------------
9.00
Notes. and Comments
----------------- ---------------Special
90 LF 6' SLUMPS.TONE'BLOCK WALL ALONG
WEST P/LAND FRONT. GENERAL CONTRACTOR
ALSO DOING CONCRETE FLATWORK AND TILE -IN
POOL.
Fee -summary------ Charged_-- _--paid---.
_Credited•
Permit Fee Total 54.00
-_-_Due
00. 00
54.00.
Plan Check Total .00
.00 .00
Grand Total 54:00_
.00 .00
..00
54.00.
P.O. BOX 1504
78-495 CALLE TAM Pico VOICE (760) 777-7012
LA QUtIvrA, CALIFORNIA 92253 FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: D - Date:
Applicant: Architect or n (neer.
Applicant's Mailing Address: Architecfor Engineer's Address:
.Lic.. No..
MUILUINU PERMIT 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 Uce9Sis in full force and effect
License Class � License No. j
00,
Date 2 f', 04: Contractor
.. 4'
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for the foltowing 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—Myvkgabd of'Secb�031-5-by —any for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 1, as owner of the property, or my employees with wages as their sole compensation, will do the worts, and the structure Is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contiactors' 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) licensednt to
the Contractors' State License Law.). pursua
U 1 am exempt under Sec.. BA P.C. for this reason.
Date Owner
WORKERS' COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self4nsure 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. workers' compensation insurance carrier and polis number are:
r d Policy Number l '71/--17003
:y,Camer S�++i.
_ I certify that .in the performance of the work for which s permit is issued, I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
Applicant
WARNING: FAILURE TO SECURE W KERS' COMPENSATION 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 COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 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, Clv. C.).
Lenders Name
Lender's Address
IMPORTANT Application is hereby made to the Director of Buildin APPLICANT SSafety CKNOWLEDGEMENT
I. Each g Apermit subject to the conditions and restrictions set forth on this application.
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 Ouinta, 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 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
I certify that 1 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 enter upon the above-mentioned property for inspection purposes.
Date S L y! `.. /L;; ' Signature (Applicant or Agent):
rte'-