05-4440 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00004440
Property Address: 52346 SHINING STAR LN
APN: Z 767-200-999=48 -3120222`
Application description: WALL/FENCE.
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 250
Applicant:
�J
Architect or
Tu�/ 4 4 a"
f' /P ',
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner.
Q DESERT ELITE,
78401 HIGHWAY
LA QUINTA, CA
O (760)777-9920
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
INC.
111, SUITE G
92253
Contractor:
HERINGTON DEVELOPMENT, JAMES O
40960 CALIFORNIA OAKS RD, #283
MURRIETA, CA 92562
(951)677-8415
Lic. No.: 753190
Date: 10/03/05
LICENSED CONTRACTOR'S DECLARATION 11 -
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: 13 L' a se : 7W190 -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
�/ issued.
ate:�� ractor:
pLI 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 perjury that I am exempt from the Contractor's State License Law for the
Carrier, STATE FUND Policy Number 1542746
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 repairany 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 w kers' co pensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
700 of the Labor Cod shall forthwith co ly, ' h tho rovisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
Jt_L7 -
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
"`�` plicant: Ua
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 Coder The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAG(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 ($100,000). 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 orACKNOWL
-
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. , BAP.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
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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
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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 he y a thorize representatives
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of this cou y tolenterypon the above-mentioned property.fo spection purpose
Lender's Name:5
6
Dat Si ure (Applicant or Agent):
Lender's Address:
LQPERMIT
f LQPERMIT
Application Number, .. . . . . 05-00004440
Permit . .
WALL/FENCE PERMIT
Additional desc .
Permit Fee
15.00 Plan Check
Fee
.00
Issue Date
Valuation
250
Expiration Date
4/01/06
Qty Unit Charge Per
Extension
-
BASE FEE
15.00
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Special Notes.and
Comments
10 L.F. 6' GARDEN
WALL, ORCO SYSTEM
Fee summary
Charged Paid, Credited
----- ----------
Due
-----------------
Permit Fee Total
- ---- ---------- ----------
15.00 .00
.00
15.00
Plan.Check Total
.00 .00
.00
.00
Grand Total
15.00 .00
.00
15.00