08-0369 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA�QUINTA,'CALIFORNIA 92253
Application Number:
08`000,0.03.6.9.
Property Address:
57431 PASEO—DE LA PAZ
APN:
764-010-008-15 -31910 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
6400
Applicant:
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
NSED CONTRACTOR'S DECLARATION
I hereby'affirm untlerpenalty of fury that d u r provisions'of Chapter 9 (commencing with
Section 7000 .ofDivision 3 o he Busi and Pr ssio ' s Code, and my License is in full force and effect.
License Clas . B License No.: 753190
v� ontrac
OWNER -BUILDER DECLARATION
I hereby affirm under penalty.of perjury that I amiexempt from the Contractor's State License Law for the
,.following reason (Sec: 7031.5, Business.and Professions Code: Any city or county that requires 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 Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 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 acivil penalty of not more than five hundred dollars ($500).:
1 _ I '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 -dots; not apply to an owner of property who builds or improves thereon,
.and who does the work himself or herselfthroughhis or her own employees, provided that the
improvements are not intended or'offeied for sale. If, however, the building or improvement is soldwithin
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.).
(_ ) I, 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.).
(_) I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
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: l l
Lender's Address: N A
LQPERMIT
Owner:'
LA QUINTA 57 ESTATES INC
78401 HWY 111 STE G
LA QUINTA, CA 92253
Contractor:
HERINGTON DEVELOP INC, J
40960 .CALIFORNIA OAKS RD
MURRIETA, CA -92562
(951)677-8415 .
Lic. No.: 753190
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/29/08
S O IX U
MAR p 6 2003
. U
CITY OF LA QUINTA
FINANCE DEPT.
WORKER'S 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 and policy number. are:
Carrier STATE FUND - •Policy Number 1542746-2007 '
I certify that, in the performance of the work for which this permit is issued, I'shatl not employ any
person in any mann to bjec o the workers' compensation laws of California,
an agree that ' should- me s ec[ t he the
compensation provisions of Section
00 of th abor _ I shah wit omply with those provisions.
WARNIN6. FAILURE TO SECURX E®KERS' d'0MPENSATION 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.
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 days from date of issuance of such permit, or cessation of ork for 180 days will subject
permit to cancellation. -
I certify that I have read this application and state at the abov tion i 'orrect. I agree to comply with all
city and count ordinances and state laws relat g to buil ' constr tion,. " d hereby authorize representatives
of this count to a er upon the above -menti ed pr rty for c ion ' rposes.
te: nature (Applicant Agent): G
Application Number . . . . . 08-00000369
Permit . . . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 90.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 6400
Expiration Date . . 8/27/08
Qty Unit Charge Per
Extension
BASE
FEE
45.00
5.00. 9.0000 THOU BLDG
2,001-25,000
45.00
----------------------------------------------------------------------------
Special Notes and Comments
256 L.F. 6' GARDEN WALL @ SIDE &
REAR,
ORCO SYSTEM
Fee summary Charged
-----------------
Paid
Credited
Due
------------------=-
Permit Fee Total 90.00
----------
.00
----------
.00
90.00
Plan Check Total .00
.00
.00
.00
Grand Total 90.00
.00
.00
90.00
LQPERAIIT