04-4886 (BLCK)�I
BUILDING & SAFETY DEPARTMENT
P.O. Box. 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number
A4=0.0-0-0488-6Date.
6/11/04
Property Address . . . .
55765 TURNBERRY WY'
APN:
767-550-017- - -
Application description . . .
WALL/FENCE
Property Zoning . . . . .
LOW DENSITY RESIDENTIAL
Application valuation
304 _
Owner
Contractor
DAO INVESTMENTS
LAWRENCE, BUSTER L.
.P.O. BOX 1286
.9639 FOLARIS WAY
SUNSET BEACH CA 90742
MORONGO VALLEY
CA 92256
(760) 2.72-5472
WCC: STATE FUND
WC: 17445692003
08/11/04
CSLB: 328825
06/30/06
CCC: B
Permit . . . . . . *WALL/FENCE PERMIT
Additional desc
Permit Fee . . . 15.00 Plan Check Fee
.00
Issue Date
Valuation
304
Qty Unit Charge Per
Extension
..BASE FEE
15.00
Special Notes -and Comments`
19 L.F. 4' BLOCK WALL, 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
D 114� U
JUN 11 200
CITY OF LA QUINTA
L
P.O. BOX 1504
7$-495 CALLS TAMPICD I�
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: n
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
VOICE (760) 777.701:
FAX (760) 777-701 ;
INSPECTIONS (760) 777-715.
Date: (o If / - J
rvtrnuect or engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perlury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code• and my Lice n is in full force and effect.
-----License Class � No.
Date —ontractor
I hereby affirm under penaltyof OWNER43UILDER DECLARATION
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 1, 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 We (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. It. 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 t am exempt under Sec. . B.d P.C. for this reason
Date Owner
I herebyaffirm under WORKERS' COMPENSATION DECLARATION
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 pertnil is
iSSR0.
M y orkers' compensation nnce carrier and policy number are:
artier �%tlC! /1:'(iK [i /policy Number _ 1-1_ giZZ, G2,63
_ I centry that, in the performance of the work for which this permit is issued. I shall not employ an
y person in any manner socompensation laws of California. and agree that. if I should become subject to the workers' compensation provisions ons of Sections to b370000 of the bor CC workers'
/ forthwith Comply with those provisions. p octet I shall
ate 4/ A' p ti ngpl <
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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury that there is a construction lending agency
for tLENDING oPerformance
Of
he work for which this
9 cY
Lender's Name permit is issued (Sec. 3097, Civ. C.).
Lenders Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
Application is hereby made to the Director of Building and Safety for a pernit 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 OuiMa, 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 dayd from date of issuance of such perpit, 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 stats laws relating to building
construction, and hereby authorize representatives of this county to enter upon the above-mentioned property, for inspection purposes.
00
/ Date �- S� re (Applicant or Agent): �—
I