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04-5722 (BLCK)TA -ht 4 -4 Q" P.O. Box 1504 - ,78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT 4 (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number 04-00'005722 ~f Date 04 Property Address54342 SHOAL CREEK —2/26 APN: 775-060-004-. � - Application description WALL/FENCE Property Zoning . . . . . LOW DENSITY RESIDENL rFINANCEDIEPT. 2 6 2004' Application -valuation 1100 ®FLAQUINTA Owner Contractor SMITH ROBERT W HILL'S CABINET MFG, INC. 71923 DESERT DR 83680 CITRUS AVENUE RANCHO MIRAGE CA 92270 INDIO 'CA 92201 (760) 342-1182 WCC: 'STATE FUND WC: 1640645 01/01/05 CSLB: 368543" 01/31/05 --------------------------------------------------------------------------- CCC: C6 -------------------------------------------------- Permi Permit . . . I. . . WALL/FENCE PERMIT --------------------------- Additional desc Permit Fee. 27..00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 1100 Qty Unit Charge Per Extension BASE FEE 15.00 6.00 2.0000 HND BLDG 5'01-2,000 12.00 -------- ---------- ------------------`---------------------- -`==--w----------- Special Notes and Comments 44 LF 6' BLOCK WALL,PER.ORCO STANDARD Fee summary Charged _Paid Credited Due Permit Fee Total 27.00 .00 .00 27.OQ Plan Check Total .00 .00 .00' .00' Grand Total 27.00 .00 .00 27.00" P.O. BOX 1504 • VOICE (760) 777-7012 'G�� 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: d �f �S 7 Applicant: Applicant's rvTailing Address: Date: c:. Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisionMX-5-V7 Chapter 9 (gocing with Section 7000) of Division 3 of the Business and Professionals Code, and my Licens is in full force and effect. SS Y License Clas ense No. . - 7� 4,7y— k Date 6 Contractor 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 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. , BA P.C. for this reason Date 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 _t,suedd.. My worke compensation insurance carrier and num r a� Carrier J fJwre re Policy Number ��6�J I certify that, in the performance of the work for wh' h this perm' is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and a ee th , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisio Date Applicant 7�Z WARNING: FAILURE TO SECURE WORK RS' COMPENSATION COVERAG WFUL, 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 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.). Lenders Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building 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 the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Oulnta, 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 id if wo;aiZme. commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancell do . I certify that I have read this application and state that the above info n is o comply with all city and county ordinances and state laws relating to building constructio and hereby authorize representatives of this county to e r upon the ove entioned property for inspection purposes. G Date �/ b Sighature (Applicant or Agent):