05-0183 (BLCK)0
BUILDING & SAFETY DEPARTMENT
P.O..Box 1504 (760).777-7012
.78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92233 INSPECTION REQUESTS (760) 777=7153
BUILDING PERMIT
Application Number . . . 05_0-0-0-0-0.1.83 Date 1/19/05
Property Address . . . 77780 CALLE SINALOA
APN: 7'73-141-011-11 -000000-.
Application description WALL/FENCE
Property Zoning COVE RESIDENTIAL
Application valuation . ,6083
Owner Contractor..
POWER FINANCE CONTEMPORARY HOMES INCORP
P.O. BOX 134.. P.O. BOX 1141
LA QUINTA CA 92253. LA QUINTA CA 92253
WCC: STATE FUND
WC: '16764082004 07/01/C5
CSLB: 736920 03/31/C5
CCC: B'
Permit. WALL/FENCE PERMIT
Additional.desc
Permit Fee . . 90.00 Plan -Check Fee .00
Issue Date Valuation . . 608---
Qty
08=Qty Unit Charge Per Extension..
BASE FEE -45.0C
5..00 9.0000 THOU BLDG 2,001-25,000 45-.00
------------
Special Notes and Comments
200 L.F: 6' BLOCK WALL, 50 L.F. 5'
COURTYARD,WALL, BOTH CITY STANDARD
Fee.summary Charged Paid Credited Due
Permit Fee Total 90.00. 00 .00. 90.00
.Plan Check Total .00 .00 .00 .00
Grand Total 90:00 .00 .00 90.00
1 D e R�-QCIUINTA
JAN CI IFIF NAOF LA
rt
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLS TAMFIcO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: D S " /15.3
Applicant:
Applicant's Mailing Address:
Date: /Ito? OS
Architect or Engineer:
Architect or Engineer's Address:
A
Lic. No..
MUILLJINU FtKMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions��te� mg ncingo-th Section 7000) of Division 3 of the Business and Professionals
Cie, and my License is i ull force and effect. �
�Cicense Class icense No.
�e Contractor co 11—H r
OWNER -BUILDER DECLARATION
I ereby 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 he provisions of the Contractors' State License Law (Chapter 9 (commencing withSection 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt `herefrom 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 he 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 he project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves hereon, 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.
have and will aintain workers' c pensation insurance, as required by Section 3700 of the Labor Code, for the performance of he work for which this permit is
or
My orkerpet, nsu carrier�ndgolis,nymberPre�d`Z�artier e c fTj(u Number�b 7 d�I certify that, in t p rformanwork for which this permit is issued, I shall not employ any pdrson in any manner so as to become subject to he workers'
mpensaf 17 �yyus-af-�alifomia, and agree that, if I should become subject to he workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwit o with those provisions.
ate / 2 v APPI � i` `, , ✓l '? L( C Y —&/ S
/FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
U
-S P TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
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 orJthe performance of he work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name Q
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 indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work being ed unde following issuance of this permit.
2. Any permit issued as a result of this application becomes null A�vold snot comme within 180 days from date of issuance of such permit, or
cessationofwo for 180 days will subject permit to cancellatiI certify that I ve readapplication a d state that the above inform1 agr o comply with all city and county ordinances and state laws relating to building
constructio nd here tho cares ntatives of this county t er - entioned property or inspeMlr+^ ^ --ses.
(Applicant or