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07-2866 (BLCK)P:'O. BOX 1504. '78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 07-00002866 Property Address: 81919 THOROUGHBRED TR APN: 767-200-999-25 ,-312024- Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 3225 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT. BUILDING PERMIT Owner: DESERT ELITE , INC. 78401 HIGHWAY 111; SUITE G LA QUINTA, CA'92253 (760)777-9920 Contractor: HERINGTON DEVELOP 40960 CALIFORNIA C MURRIETA,, CA 92562 (951)677-8415 Lic. No.: 753190 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 MEg--N U #283 NOV o 12007 OF LA Date: 10/30/07 ' -LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals C de, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class:' B Li 190 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is 1.:75 issued. Date: %j 0 Contractor: _ 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 0 NER-BUILDER DECLA ATION - - insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE' FUND Policy Number 1542746-2006 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to thpoork s' compensation provisions of Section . License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 700 of the Labor Code -1) 111orth ith co wi hose p visions. 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).: - Date fib lh­Applicant: (_) 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 WARNING: FAILURE TO SECURE W ERS' CO PENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND • ,_ and who does the work himself or herself through his or her own employees, provided that the - DOLLARS ($100,000). IN ADDITION TO THE COST: OF COMPENSATION, DAMAGES AS PROVIDEDFORIN _ improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' 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 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 contractor(s) licensed pursuant to the Contractors' State License Law.). (_) 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.). Lender's Name: Lender's Address: LQPERMIT _ 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. ' I . 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 state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to buildin construction, and hereb thor' a representatives of this county to enter upon the above-mentioned property inspection purpos s Date: //"— ('r L) )Signature (Applicant or Agent):