05-3418 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,'CALIFORNIA 92253
Application Number: 05-00003418
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Property Address:
78712 SIENA CT
APN:
609-530-016-16 -28457 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation: -
446 -
Applicant: 1 rchitect or Engineer:
d
A11G 0 3 2005 •
®¢ 41-
cauae�r�
CiiY DEP�•
-------- �—= 1------=
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 License is in full force and effect.
License Class: C5533` License No.: 823017
- Date:' ��' Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the -
following reason (Sec. 7031.5, Business and Professions Coder -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' Contractor's 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-( 5500).-:—'--•
(_) 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 through his or her own employees, provided that the
- -- _-- --_ --
--improvementsare not intended or•offeredfor 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.). -
(_ 1 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 contractors) licensed
pursuant to the Contractors' State License Law.). "
(_ 1 I am exempt under Sec. , B.&P.C. for this reason -
Date:
Owner:
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:
LQPERMIT
VOICE (760).777 -7012 -
FAX (760) 777-7011
INSPECTIONS (760.) 777-7153
Date` 8/03/05
Owner:
HIRSCHFEILD BOB
78-712 SIENA
BLYTHE, CA 92225-3
(760)86172235
Contractor:
MCRAE POOL & SPAS'
79105 DESERT STREAM DR
LA QUINTA, CA 92253
(760)774-6343
Lid. No.: 823017
WORKER'S 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 EXEMPT Policy Number EXEMPT
_. 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 Code,
I shall forthwith comply with those provisions.
-Date: �. =��-Applicant:=r �-_
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION -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 ATTORNEY'S FEES.-
APPLICANT
EES,
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 Quinta, 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 eentertrpon the above-mentioned pro or inspection purposes.
Dater F'Signature (Applicant or Age • -
r
o
LQPERMTT
Application Number . . . .". 05-00003418
Permit_" . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00
Plan Check
Fee..
.00
Issue Date . . . .
Valuation
446
Expiration Date.. 1/30/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and.Comments
-- ----------
-
6 LF 4' BLOCK WALL EQUIPMENT
ENCLOSURE/14 LF 6'"BLOCK WALL. ALL
WALLS PER CITY STANDARD.
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
LQPERMTT
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CITY OF LA QUINTA
BUILDING $ SAFETY DEPT,
APPROVED
FOR CONSMUctON
ee.m
77Y-63,43
• A RE -INSPECTION FEE -O .0>; .::;: $'
S :I ENA WILL BE CHARGED IF THE APP QVED
LA . ( U iNT4 PLANS AND JOB CARD ARE N M ON r A:r
THE SITE FOR A SCRE ULED . >'
INSPECTION.
S6. NO EXCEPTIONS!` :n
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