04-6566 (BLCK)BUILDING & SAFETY DEPARTMENT
"P.O.-Box 1504
(760).777-7012
Of- - 78-495 CALLE TAMPICO 4• FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS -.(760) 777-7153 "
BUILDING PERMIT
Application -Number 04-000_06566 Date 9/30/04
Property Address . . 57990 TROON WY
APN: 7621-360-014- 7 -
,Application description WALL/FENCE '
Property Zoning LOW.DENSITY RESIDENTIAL
Application valuation 3475
Owner Contractor
---------------
WEISKOPF PARTNERS I, LLC SOUTHERN HILLS DEVELOPMENT -INC
8107.0 CHANTICLEER 81.070 CHANTICLEER DR
.LA QUINTA CA 922.53 LA QUINTA CX 92253
" (.760) ,771-3497
"WCC: EXEMPT
WC: .:EXEMPT. 05/31/05
CSLB: 838041 05/31/06
C.CC : B
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Permit WALL/FENCE PERMIT
Additional desc
Permit, -Fee 63.00 Plan Check Fee 00
Issue Date Valuation .3475
Qty Unit Charge Per Extension
BASE FEE 45.00
2.0.0 9'.'00.00 THOU BLDG 2,001725,000 18.00
Special Notes and -Comments
139 L.F:.6' BLOCK WALL, ORCO SYSTEM
Fee summaryCharged 'Paid, Credited Due
-
------------- - -"-, -------------------- =-- --------
Permit
- - Permit Fee Total, 63-.0.0 00 .00 63.00
Plan Check Total .00 .00 00 00•
Grand Total'., 63.00 .00 00 63.00.
-to2004
c fT�i -0 4T
CITY OF a 4UIP1TA
FINANri; nmoir
P.O. BOC 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
VOICE (760) 777-7012
FAX (760) 777-7611
INSPECTIONS (760) 777-7153
Date:
Architect or Engineer's Address:
Lic. No.:
BUILDING 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
C , and my Licens8js in full force and effect.
icense Class /� i�C"cense No. 38O
FWA=0r_1:;
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of pe ry 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 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 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. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I 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
issued. My workers' compensation insurance carrier and policy number are:
Cartier Policy Number
I 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 Labor Code, 1 shall
forthwith comply with those provisions.
_/_ D
WARNING: FAILURE TO SECURE W ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDREWTHOUSAND 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
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
Lenders Address Q
APPLICANT
IMPORTANT Application is hereby made to the Director of Buildin and SaACKNOWLEDGEMENT
Ato the
orth on this
1. Each person upon whose behalf this application is made, each person at we whose request and and -for whorse benefitrestrictions
work snperfo fm ed under or pulrsuant 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 La Quinta, its
officers, agents and employees for any act or omission related to to 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 in ation is correct. 1, agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this cou to a ter upon the above oned p y for inspection purposes.
D d /—D ignature (Applicant or Ag
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