04-6559 (BLCK)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504' .(760).777-71012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA' QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number. . . .
Property Address.
APN:
Application description
Property Zoning . .
Application valuation
0 00006559 Date 9/30/04
81050 SHINNECOCK HILLS
762-330-005- - -
WALL/FENCE.
LOW DENSITY RESIDENTIAL. }
3700
Owner. Contractor
WEISKOPF PARTNERS I, LLC SOUTHERN HILLS DEVELOPMENT INC
81070 CHANTICLEER 8107.0 CHANTICLEER DR
LA QUINTA CA 9225.3 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 . . . 3700
Qty Unit Charge Per Extension
BASE FEE 45.00
2.00 9.0000,THOU BLDG 2,001-25,000 18.00
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Special Notes and Comments
148'L.F.'6' BLOCK WALL, ORCO SYSTEM
Fee summary" Charged Paid Credited Due,
-- - - - - - - - - - - - - - ------ - - - - ------ - -
- ------------ ---- __--
Permit Fee Total 63.:00 .00 .=00 ,.3.00
Plan Check, -Total .00 -:00 O 00 .00
Grand Total 63.00 .00 OC-�.�O0t�004 6 ..00
FAQ �►
CI'6`d o:rG��
P.O. Box 1504
78-495 CALLS TAMPICO ���� FAX (760) 777-7011
411 � VOICE (760) 777-701:
LA QUINTA, CALIFORNIA 922534 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: _ - 4955LI Date: �� '� • d
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
ItSUILUING PERMIT DECLARATIONS
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
tic and Licens in full force and effect.
icense Classss ense No. d
—/-0
OWNERaUILDER DECLARATION
I hereby affirm under penalty of perjury 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 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 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.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , B.8 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 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 carrier and policy number are:
Carrier 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 subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code1 shall
forthwith comply with those pro%vions. ---2,
—b
WARNING: FAILURE TO SECURE O KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDR 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 Building and Safety for a
orth on this
1. Each person upon whose behalf this application is made, each person at permit
restrictionsconditions and
e request a d for whose benefit s
rk perfo (rrned under or pulrsuant to an
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 Ouinta, 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.
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 ter upon the above -menti ad pro for inspection purposes.
ate �—Z;l Signature (Applicant or Age ):