08-0370 (BLCK)P.O. BOX.]504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number:
0'8>, 00000370—
Property Address:
574.03aPASEO—DE LA PAZ.
APN:
764-010-008-16 -31910 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
4667
Applicant:
Architect or Engineer:
PIP
LICENSED. CONTRACTRR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm. underpenalty of per' icer and (provisions'of Chapter 9 (commencing with
Section 700(;) of D'vision3 of Busine and siona Code,.and my License is in full force and effect.
License.Cla/: icense No.: 753190
Da� b O�i ontr or
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following 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 Contractor's 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. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(_ 1 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 does not apply to,an owner of property who builds ei improves thereon,
and who does the work himself or herselfthrough his -or her -own employees, provided that the .
improvements are not intended or'offered for sale. If, however, the buildingorimprovement 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.).
(_) 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. , B.&P.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:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760).777-7011
INSPECTIONS (760) 777-7153
Date: 2/29/08
Owner:
LA QUINTA 57 ESTATES INC
78401 HWY 111 STE G
LA QUINTA, CA 92253 D
MAR p 6 "LO��
Contractor:
HERINGTON DEVELOP INC, . AM er( OF =A PT
4096,0 CALIFORNIA OAKS R #283FIi4A�CIE
MURRIETA, CA 92562
(951)677-8415
Lic. No.: 753190
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, asrequired 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 perform f t - whi this permit is issued, I shall not employ any
person in any man so as t me lett t he workers' compensation laws of California;
and ree that ' 1 should comes ct to workers' compensation provisions of Section
37 of.the. r o shall f ith c ply with those provisions. .
^O
v pli ant: t✓
W NI FAIL RE TO RE WORK RS'C PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJEC 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 worklis 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 day's from date of issuance of such permit cessati of work for 180 days will subject
permit to cancellation.
;at
that I h ve read this application and s that the a ve info a ' n co ct. I agree to comply with all
coup ordi antes and state laws r ating to w g construc and reby authorize representatives
ou to ter up the above -me tioned pr f insp pur ses.
nature (Applicant Aged
Application Number . . . . . 08-00000370
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 72.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 4667
Expiration Date 8/27/08
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
179 L.F. 6' GARDEN WALL & 12 L.F.
4'
COURTYARD WALL, BOTH ORCO SYSTEM
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
LQPEP-MIT