05-2711 (BLCK)P.O. BOX 1504. VOICE 760 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA,.CALIFORNIA 92253 BUILDING &SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/01/05
Application Number: OS711', Owner:
Property Address: 4-8583 STILLWATER DR IVANHOE LA QUINTA COVE
APN: 658-140-999-128--29436 - C/O R BARRY MCCOMIC
Application description: WALL/FENCE 7979 IVANHOE AVE STE 550
Property Zoning: LOW DENSITY RESIDENTIAL LA JOLLA, CA 92037
Application valuation: 3160
DContractor:
Applicant: Architect or Engineer -TRANS WEST HOUSING, INC.
AUGU1' 9 �f �jj� WCC: STATE FUND
F u WC: 1648813 10/01/05
CSLB: 701039 01/31/07
0 I T f�/�G 101 c►n' ®� t,a �yo3�
FIIUAM aee .... ��
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: � /L�icenyse N''1�LdL ate:a��/T /P� Contracto j -craws �11i)J '3lS(,(,L/j�
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 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 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 ($500).:
(_ 1 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 -
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.).
(_) I, as owner of the property, am exclusively contractingwithlicensed 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.).
1 _ 1 I am exempt under Sec. - , B.&P.C. for this reason .
Date: Owner:
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.1. -
Lender's Name:
Lender's Address:
LQPERMIT
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 far workers' compensation, as provided
for by Section 3700 of the Labor Code, for the performance ofthe 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 B 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 shou� become subject to th workers' compensation provisions of Section
3700 of the L_ab/or/Co , I II forthwith co y ith those provisions.
ate: IfApplicant
WARNING: FAILURE TO SEC
U E 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 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 stateAaabrmation is correct. I agree to comply withall
city an ounty ordinances and state laws relatinction, and hereb authorize representatives
oft cou ty to enter upon the above-mentionedtion purposes.date: 0� Signature (Applicant or Agen
i Application Number . . . . . 05-00002711 '
Permit WALL/FENCE PERMIT
Additional desc -
Permit Fee . . . . 63.00 Plan Check
Fee
.00
Issue Date Valuation
3160.
Expiration Date 12/28/05
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00 9.0000 THOU BLDG.2,001-25,000
--
18.00
-----------------------------------------------------
Special Notes and Comments
-------
--------------
LOT 128 PLAN 2 ELEV A 120 L.F. 61_BLOCK
WALL AND 10 L.F. 4' BLOCK WALL, ORCO
SYSTEM.
Fee summary Charged Paid Credited
Due
Permit Fee Total 63.00 .00
.00
63.00
Plan Check Total .0.0 .00
.00
.00
Grand Total 63.00 .00
.00
63.00
LQPERAiTT