04-4885 (BLCK)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 ;..0.4-00-004885 -� Date 6/,11/04
Property Address .. . . . . 55795 TURNBERRY WY
APN: .767-560-001-
Application
767-560-001 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),272-5472
WCC: STATE FUND
WC: 17445692003 08/11/04
CSLB: 328825 06/30/06
CCC: B
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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
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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
P.O. Box 1504 • �G� VOICE (760) 777-701:
7$-495 CALLE TAMPICO �I
LA QUINTA, CALIFORNIA 9225344 FAX (760) 777-70l;
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777.715?
Application Number: (5 /
Applicant: Date: c0 f — O
Architect or Engineer.
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
I herebyaffirm under LICENSED CONTRACTOR'S DECLARATION
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 Llcenje in full force and effect. /
license Class_ License No.S��Q' S�
�6ate �� � � ••+U�-Lit:ontraaor�
I hereby affirm under persalt of OWNER -BUILDER DECLARATION
y 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 sublects
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 irnproves 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.).
(, 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.).
U I am exempt'under Sec. . B.6 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' compensa insurance, as required by Section 3700 of the Labor Code• for the performance of the w
-issued. My workers' compensatio ' urance carrier and policy number are: ork for which this permit is
artier Policy Number �' LL� S`G i� :a
1 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
forthwith comply with those provisions. Labor Code,'I shalt
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.
I hereby affirm under penalty of perjury that there isa construction lending aSTRUCTION LENDING AGENCY
Lender's Name
agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
Application is hereby made to the Director of Building and Safety for a permit subject to then 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
2
officers. agents and employees for any act or omission related to the work being performed under or following issuance of this permit. u Quints. its
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 of
cessation of work for 140 days will subject permit to cancellation.
I certify that, I have read this applicatiori and state that the above information is correct I agree to comply with all city and county ordinances and state
laws rotating f0 building
construction, and hereby auprop"
representatives of this county to enter upon the above-mentioned PertY for inspection purposes.
ate 1D tis gnaturo (,applicant or Agen ��