05-2199 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
0.5-0 00
02199
Property Address: j•5488`6`TANGLEWOOD
APN: 775-052-0.067 - -
Application description: STRUCTURES OTHER THAN BUILD
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 800
Applicant:
'Trtd' °�' +`F'Qr�GtTw
Architect or Engine
0 /A
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
TOM• KILGERGER
54886 TANGLEWOOD
'LA QUINTA, CA 92253
Contractor:
BELLA FLORA LANDSCAPE INC
50656 CALHOUN STREET
COACHELLA, CA 92236
(760)578-5137_
Lic. Nb.: 834604
VOICE (760) 777-7012
FAX (760) 77777011'
INSPECTIONS (760) 777-7153
Date: 6/07/05
' LICENSED CONTRACTOR'S DECLARATION -
1 WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C27 A License No.: 8346V
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date:ntractor:
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
,�
_ OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of per' ry that I am exempt from the Contractor's State License Law for the
Carrier EVEREST NATL Policy Number 3800002278-041 '
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the _
person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the workers' compensation provisions of Section
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
3700 of the Labor Code, I shall forthwith comply with those provision '
any applicant for a permit subjectsthe applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: bs'plicant:
1 _ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
IF
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL _
. Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the I
DOLLARS ($100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. '
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.)..
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project.(Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
' property who builds or improves thereon, and who contracts for'the projects with a contractor(s) licensed
,
1. Each person upon whose behalf this application is made, each person at whose request and for '
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
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.
Date: Owner:
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 '
' CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
Lender's Name:
of this co my o enter upon th bove-mentioned property for inspection p rposes..
'
.
Dat 7 � 'nature (Applicant or Agent): ✓1�'
- Lender's Address:
LQPERMIT
LQPERMIT .
Application Number 05-00002199
Permit . ... BUILDING PERMIT
Additional desc .
Permit Fee 21.00 - Plan Check
Fee
13.65
Issue Date . . . Valuation
800
Expiration Date 12/04/05
Qty Unit Charge Per
Extension
BASE FEE
15.00
3.00 2.0000 HND BLDG 501-2,000'
6.00
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . 18.00 Plan Check
Fee
4.50
Issue Date Valuation
0
Expiration Date.. 12/04/05
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
Special Notes and Comments
FIREPIT - 4' DIAMETER, 12" HEIGHT..
75,000 BTU, ANSI # Z21.58-1995/CGA.
Other Fees . . . . . ENERGY REVIEW FEE
1.37
Fee summary Charged Paid Credited
Due
Permit Fee Total 39.00 .00
.00
39.00.
_ Plan Check Total 18.15 .00
'00
18.15
Other Fee Total 1.37 .00
.00
1.37
Grand Total 58.52 .00
.00
58.52
LQPERMIT .