04-4503 (BLCK)BUILDING•& SAFETY DEPARTMENT
P.O. BOX 1504 (760).777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 922.53 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number 04-_00'004503 Date ' . 5/21/04
Property Address `7-8690 AVENIDA TORRES
APN:.. 770-171-011-
Application description . . . WALL/FENCE PPA
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Property Zoning . ... . LOW DENSITY RESIDENT
Application valuation''.' 8000 MAY 21' 2004
Owner �
Contra
CIT1'OFIAQIlI�iNTA
I
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RILEY LEBRUN
ADDINGTON, DAVID
.PO BOX . 1573
4176.0 HERMITAGE
DRIVE
LA QUINTA,: CA.
INDIO
CA 92201
LA QUINTA CA 92253
WCC: STATE FUND
WC': 2290019787.. 01/01/05
C.SLB : 682901
12/31/05
CCC: B.
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Permit :. ;;WALL/FENCE .PERMIT
Additional .'ciesc
Permit -.Fee. : 9.9.00
Plan Check Fee.
.00
Issue Date
Valuation
8000
��ty. Unit Charge Per
Extension
BASE FEE
4.5.00'
6.6Q... 9.0000 THOU. . BLDG 2, 001-.25,
000:
54.00
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Specid!V Notes and Comments
320 LF'6' ,$LOCK WALL PER CITY STANDARD
AND API RO'IJED. PLANS. FRONT P/L WALLS
LIMI.TED., ': c .5' .
Fee summary Charged .Paid
Credited
Due
Permit Fee Total 99.00
.00 ..00
99.00
Plan Ch6ck Total .00
.00. .00
00
Grand Total 99.00
00 00
99.00
�r •
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QuINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant ailing Address: `
' Date: QS -Z/
Architect or Engineer.
Architect or Engineer's Address:
Lic. No.:
LSUILUING 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
Code, and my License is in full force and effect. / �� O
License Class 2 License No. I
Oats l u O�
Contractor
I hereby affirm under penal of pt O ER-8UILDER DECLARATION
penalty 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_ hat.he-or-she-is-exempt-therefrom-and-the-basis-forthe-alleged-exemption—Anyviotaft of Sddffd—n7031.5by 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 1, 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.3 P.C. for this reason.
Date Owner
WORKERS' COMPENSATION DECLARATION
1 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
IF issued. 1workers' pensation insurance carrier n policy number are:
Cartier c C�l^?c� {—r Policy Number A! - -211-
permit _ I certify that, in the performance of the work for which this psuedl 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 LApplic nt
v
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.
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there is a construction lendingagency for the performance of the work for which this
� �' Pe permit is issued (Sec. 3097, Civ. CJ.
Lenders NameLenders Address
IMPORTANT Application is hereby made to the Director ofBuildin APPLICANT SCKNOWLEDGEMENT
1 Each Safety Apermit subject to the conditions and restrictions set forth on this application.
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, indemnity and hold harmless the City of Le 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.
1 certify that 1 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 enter upon the above-mentioned property for inspection purposes.
Date `i 2t O Signature (Applicant or Agent):