08-0371 (BLCK)P.O. BOX 1504
78-495. CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:08-00000371
Property Address: 57375 PASEO DE LA PAZ
APN: 764-010-008-17 -31910
Application: description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4225
Applicant: Architect or Engineer:
BUILDING &SAFETY DEPARTMENT
. BUILDING PERMIT
.UC ONTRA OR'S DECLARATION "
I hereby affirm under, penalty of per' m-licen d un r provisioris of Chapter 9 (commencing with
Section 7000 f Division 3 of a Bus" ess an r ssio s Code, and my -License is in full force and effect.
License Clas Vo -
License No.: 7531.90
r
ate,
•
WNER-BUILDER DECLARATION'
1 ereby ffirm under penalty of perjury that I am exempt from the Coutracidi'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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
(_ I I, as ownerof'the property; or my employees with wages as their sole compensation, will do the work, and
- the structure is notintended'or offered for sale (Sec. 7044, Business and Professions Code: The
Contractors' State License La`w does not apply to an owner of property who builds or 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 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.).
(_) 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) 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:
LQPERn1IT
Owner:
LA QUINTA 57 ESTATES INC
78401 HWY 111 STE G
LA QUINTA, CA 92253'
Contractor:
HERINGTON DEVELOP
409'60 CALIFORNIA
MURRIETA, CA 92.56
(951)677-8415
Lic. No.: 753190.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/29/08
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.
"1 have and willmaintain 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%. r
Carrier STATE'FUND. ._: Policy Number 1542746-2007
1 certify that, in the performance of the work for w ich this permit is issued, I shall not employ any
person in any mann e c o m e biec o the workers' compensation laws of California,
and agree that ' shoul ec a s C - the woikers'. compensation provisions of Section
00 of th abor I shall it omply with those provisions.
'� APPIi ant:
+ WARN( G: FAILURE TO ECURE. WO ER OMPENSAT.ION 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 performe'd 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 work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state th a abov a n is c rect. I agree to comply with all
city and county rdin nces and state laws resat to buildi construe , an ereby authorize representatives
of this county en rCC�C���up��/�on the above -men ' ned prop r ins n u oses.
ate: o�ture (Applicant r Age C
Application Number . . . . . 08-00000371
Permit . . . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee 72.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 4225
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
169 L.F. 6' GARDEN WALL @ REAR &
SIDE
YARD, 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
LQPERAI[T