04-6557 (BLCK)a/
C&y
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495. CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number !C04=00006557 Date 9/30/04
Property Address . . . . . . 81075 SHINNECOCK HILLS
APN: 762-330-010= - -
.Application description . . . WALL/FENCE
Property Zoning . . . . . . LOW DENSITY RESIDENTIAL
�Application�valuation . . . . 28.00
Owner Contractor
WEISKOPF PARTNERS I, LLC SOUTHERN HILLS DEVELOPMENT INC
81070 CHANTICLEER 81070 CHANTICLEER DR
LA QUINTA CA 92253 LA QUINTA CA 92253
(160) 771-3497
WCC: EXEMPT
WC: . EXEMPT 05/31/05
CSLB: 838041 05/31/06
CCC: B -
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Permit WALL/PENCE PERMIT
Additional desc
Permit Fee 54.00 Plan Check Fee .00
Issue Date Valuation . . . . 2800
Qty Unit Charge. Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG 2,001-25,00.0 9.00
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Special Notes and Comments
112 L.F. 6' BLOCK WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due.
Permit Fee Total 54:00 .00 .00 54.00
Plan Check Total .00 .00 .00 .00
.Grand Total 54.00 .00 .00 54.00
6
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P.O. BOX 1504 /: .
78-495 CALLS TAMPICO w VOICE (760) 777-701:
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0 — &55.s Date: �(� • f • o q
Applicant: . I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
OUILUIIYti rtKMI I ULULAKAT1oN5
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 Li�in full force and effect. ,Q /
,---ticense Class I/ n cense No. f
—1-6
OWNER43UILDER DECLARATION
affirm I hereby arm under penalty of pe that 1 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 pe 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 of 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 their 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 License 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 have the burden of proving that he or she did not build or improve for the purpose of sale.).
e project : The Contractors' 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Profes
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the with a t sions cions to Codede 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.
_ 1 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 insurance tamer and policy number are:
Cartier Policy Number
I 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 subjectto the workers'
compensation laws of Califomi, n agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall
forthwith comply with those p ovisro s. -1-7 ---7
O—/— Q
WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HU D THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I 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
Lenders Address /
APPLICANT
ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Buildingand Safety A
s set forth on this application.
1. Each person upon whose behalf this application is made, each person at Permit
fe request d foto the r whose benefions and t work snperformed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Quints, 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 date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
1 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 coun enter upon the above -m •oned pro for inspection purposes.
�� ��
Signature (Applicant or Agent):
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