06-1723 (BLCK)Fr7. BOX 1504
7495 CALLE TAMPICO
' LA QUINTA, CALIFORNIA 92253
Application Number: 06-00001723
Property Address: 79020 SHADOW TR
APN: 649-030-069-19 -31310 -
Application description: WALL/FENCE
Property Zoning: . HIGH DENSITY RESIDENTIAL
Application valuation: 4925
Applicant: Architect or Engineer:
N`
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SANTA ROSA DEVELOPMENT INC
46753 ADAMS ST
LA QUINTA, CA 92253
(760)771-3345
Fr
Contractor:MAFFEI, DAVID'LETTERIELL
1451"QUAIL STREET, #212 LJ
NF?dPORT BEACH, CA 92660
(949)'863-9642
Lic. No.: 375176
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/03/06
r
MAY o 4 .zoos �1
CITY OF I^ jwtU#j 11^
FINANCE"� C�-_J
LQPERMIT
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
• I hereby affirm under penalty of perjury that I am licensed under pr visions of Chapter 9 (commencing with -
I hereby affirm under penalty of perjury one of the following declarations:
Section 70001 of Division 3 of the Business and Professionals Coe 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: B Licens No.: 375176
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
'
ate Con tor: .,,r
issued.
�I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
v-� Code, for the performance of the work for which this permit is issued. My workers' compensation
- OWNER-BUI DER DECLARATION
insurance carrier and policy number are:
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 1620469-2006
" 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, of 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 subje4hw-ct to A workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall foro ly with those provisions.
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).:
"�:cant:
(_) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
1
_
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The.
WARNING: FAILURE TO SECURE WORKERS' 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
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 ovimprovement 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 _ 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 1 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 ' c rrect. 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, an ereby authorize representatives
of this county to enter upon the above-mentioned property for inspectio urp as.
Lender's Name:
-
l A_
`iJ AC'
ature (Applicant or Agentl:
Lender's Address:
LQPERMIT
Application Number 06-00001723
Permit . . . WALL/FENCE
PERMIT
Additional desc . .
,
Permit Fee 72.00.
Plan Check
Fee
.00
Issue Date
Valuation
4925
'Expiration Date 10/30/06
Qty Unit Charge Per
Extension
BASE
-FEE
45".00.
3.00 .9.0000 THOU BLDG
2,001-25,000
27.00
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Special Notes and Comments
197 L -.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 72.0P>
.00
.00
72.00
Plan Check Total .00
.00 ..00
.00
Grand Total 72.00
.00"
.00
72.00
LQPERMIT