04-7081 (BLCK)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760),777-7012.
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Applicatio'i-Numbet . . . . . 04-0000708.1 Date 11/05/04.
Property Address 5364,0 AVENIDA CORTEZ
APN: 774-102-007- - -
Application description WALL/FENCE
Property Zoning COVE RESIDENTIAL -
Application valuation . . . . 7500
Owner Contractor
YOST DENNIS G PACIFIC HOMES
P 0 BOX 16006 P.O. BOX 1023
PORTLAND OR 97292 LA QUINTA CA 92247
(760) 408-3.4:95
WCC: STATE FUND
WC:. 1576557 08/01/05
CSLB: 782.324 08/31/0.6
CCC: B
------------_-----------------=-----------------------------------------------
Permit . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 99.00 Plan Check.Fee .00
Issue .Date Valuation, 750-0
Qty Unit Charge, Per Extension
BASE FEE 45.010
6.00 9.0000. THOU BLDG 2,001-25,000 54.00
Special Notes and Comments
150 if of combo wall, 2'
retainer/61wall. 150' garden walls all
city standard..
Fee summary Charged Paid Credited Due
------=------ --- ---------- ----------- -------' --------
Permit Fee Total 99.00 . . 00 n 99(� Of3-
'Plan Check Total .00 .00 �; !00
Grand Total 99.00 . Go ;'� � � 99. 0
C� LA
iliiUTrq
P.O;. BOX 1.504• �� VOICE (760) 777-7012
-78-495 CALLE TAMPiCO FAX (,760) 777-7011
LA QUINTA, CALIFORNIA 922-53 4INSPECTIONS (760) 777-71:53
BUILDING & SAFET-Y DEPARTMENT
Application Number: d �� Date:
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's d res
Lic. No.:
BUILDING 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 Linen 'sin full force and effect.
License Class_ Lioense' No.
r.
OWNER43URMF-R,DECLARATION
I hereby affirm under penalty of pedury that I am exempt from the Contractors' State' Lioense Law for the following reason (Sec. 7031.6, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish,or repair any structure, prior to Lls issuance, efso.requires the applicant for the permit b file a signed
statement #m,t 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) orthat'he or she is exempt therefrom and,the.basis for the alleged exemption. Any violation of Section 7031.6 by any applicant for a permit subjects
the applicant to a civil penalty.of not more than five hundred dollars ($500).):
U i, as owner of the property, or'my employees with wages as thea sole compensation, will do the work, and the structure Isnot 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 or improves.thereon, and who does the work
himsed'or herself or through his or, her own employees, provided that the _Improvement are not intended or offered for sale. If,'however, the building or improvementis
soli within one year of.completion, the'owner-builder will have the burden of proving that he or she did not bulld or improve forthe purpose of sale.).
U I, as owner of the property, am exclusively oontracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The.Conlractors'
State License.Lew does not apply to an owner of property who builds or improvesthereon, and who contracts for the projects with a,wn ractor(s) licensed.pursuantto
ftcontractoW State License Law.).
U I am ekempt under Sec. BA P.P.C. for this reason
Date Owner�/_J_ `
WORKERS' COMPENSATION DECLARATION
I'fiereby affirtnunde penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self4risureifor, workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this perntt 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
orkeW compensation insurance card
��
-I at, In the performance ofthe 'woik ilbr which is'permftiis:iss shall n (employ any person in any manner so as to became subject to the woik W
compensation laws of California, and agree that;.IfI should become subject to the workers' compensation provisions of Sect or3700 of the Labor Code, I shall
fo with comply with those provisions.
% ly7n
Data 64
Applicant
WARNING FA LURE'TO SECURE WORKERS' 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, ANDATTORNEY'S' FEES.
CONSTRUCTION LENDING AGENCY
thereby affirm under penalty of perjury that there is a construction lending:agency for the;perfornanceof the work for which this pernLf is:issued (Sec. 3097, Civ. C.).
Lender's Name
Lendees Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety fora pemrftt subject to the conditionsand restrictionsset 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 'asa.result.of this application, theowner, and the applicant, each agrees,to, and shall, defend, indemnify and hold harmless the City of La 00inta, 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 data of Issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
1, -certify that I have readlthis application andstate that the above'Informadon Is correct. [agree to comply with all city and county ordinances and'state laws relating Wbullding
construction, a d hyreby authorize representatives of this county to ter upon the above-mentioned property for Inspection purposes.
Date Signature (Applicant or Agent):