05-1051 (BLCK)U
BUILDING & SAFETY DEPARTMENT
Ox 1504 t J (760).777-7012
.L0
78 9 CALLE TAMPICO FAX (760) 777-701.1
QU TA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
o� BUILDING PERMIT
o r
pplication Number 05-000.01051 iDate 3/24/05
Property Address . . . . 81080 SHINNECOCK HILLS
APN: 762-330-008- - -
Application description WALL/FENCE -
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 3625
Owner Contractor
----------------------------------------`'-- - -
WEISKOPF PARTNERS, LLC SOUTHERN HILLS DEVELOPMENT INC
80070 CHANTICLEER, 78150 CALLE TAMPICO STE •101
LA QUINTA CA 92253 LA QUINTA CA 92253
(760) 771-3497
WCC: EXEMPT
WC: EXEMPT. 05/31/05
CSLB: 838041` 05/31/06
CCC: B ;
Permit . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 63.00 Plan Check Fee .'00
Issue Date . . . . Valuation . . 3625
Qty Unit Charge Per Extension
BASE FEE 45.00
2.00 9.0000 THOU BLDG 2,001-25,000. 18.0.0
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'Special Notes and Comments
145 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
----------------- ---------- =---- ---- ------ --- ----------
Permit Fee Total 63.00 .00 .00 63.00
Plan Check Total .00 .00 .00. .00
Grand Total 63.00' .00 .00 63.00
P.O. BOX 1504 ' �GI�G�
1� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 05-/05/ 1 Date:
Applicant:
Applicant's Mailing Address:
r
I hereby affirm under penalty of perjury that I am licensed
,pode, and my License is in full force and effect.
License Class
-nate .-Contractor
Architect or Engineer:
Architect or Engineer's Address:
Nl�
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Licdnse No.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 o'the Contractors' 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 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 :heir sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractors' State _icense Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through 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 nave the burden of proving that he or she did not build or improve for the purpose of sale.).
Ipp I, as owner of the property; am exclusively contracting with lizensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
I� 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner.
WORKERS' 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.
I have and will maintain workers' compensation insu.ance, 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:
Carrier Policy Number
34 certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, i` I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
ate plicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATI DN 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 ATTCRNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 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 r'
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Buildi-ig 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 performed under or pursuant to any permit
issued as a result of this application, the owner, and t..ne applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employeesfor 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 that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
ya = nature (Applicant or Agent):