04-4884 (BLCK)BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760).777-7012
78=495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number _04-.-_0.0-004-884 Date 6/11/04
Property Address . . . "55885 TURNBERRY WY
APN: .767-560-004- - -
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
----------------------------------------------------------------------------
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
Permit Fee Total 15.00
Plan Check Total .00
Grand Total 15.00
Paid Credited
.00 .00
00 nn
.00
.Due
15.00
nn
I &f 4
P.O. BOX 1504 -.
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: g
Applicant: I Architect or Engineer:
r+ppncanrs mailing Address:
VOICE (760) 777-701.
FAX (760) 77'-701
INSPECTIONS (760) 777.715-,
Date: &_//_0 I
rutrnitect or tnglneer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
I herebyaffirm under LICENSED CONTRACTOR'S DECLARATION
penalty of penury that I am licensed and provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professwnals
Lode, and my Lice is in full force and effect.
/License Class !37J6925:-
License No.
Dale_ • Q C cto a
I hereby affirm under persalt of OWNER43UILDER 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 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 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 worts
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'r the purpose o1 sale.).
U 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.& P.C. for this reason
Date • Owner
I hereby affirm under persalt of WORKERS' COMPENSATION DECLARATION
y perjury one of the following declarations:
XI 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 Portomrance
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
sued. My workers' compensation innssuranee carrier and poli n` be are: permit is
Carrier / YaT>�' i�oliev Number t� �
I certify that, in the performance of the work for which this permit is issued:l shall not Moil
em to any
compensation laws of California. and agree that, if I should become subject to the workers' pe son i nary manner
o ionerso Sas become
of the subject
or ode I shall
to the
_rs'
fortith hwcomply with those provisions. �)
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 (5100.000). 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 is a construction ONSTRUCTIONtLENDING GEENoCI� work for which this
lending agencypermit is Issued (Sec. 3097, CN. C.).
Lender's Name
Lenders Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
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 pernit
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 La Cuinta, 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 100 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 state that the above information is sorest. I agree to comply with all city and county ordinances and state laws
construction, and hereby authorize representatives of this county to enter u on the above-mentioned property for inspection purposes. rotating fo Eurldin
/Date 'O Sig (Applicant or Age lie