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04-6565 (BLCK)! oz BUILDING & SAFETY DEPARTMENT cw4 P.O. Box 1504 (766).777-7012 OF. 78-495 CALLE TAMP ICo FAX (760) 777=7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT. Application. Number 04_0-0-0-0-6-565 Date- 9/30/04' Property Address 57960 TROON'WY APN: 762"-360-013-'- - Application description WALL/FENCE Property Zoning. LOW DENSITY.RESIDENTIAL Applic"ation valuation 3550 Owner Contractor WEISKOPF PARTNERS I, _LLC SOUTHERN HILLS DEVELOPMENT INC 81070 CHANTICLEER 81070 CHANTICLEER DR LA QUINTA. CA.922153 LA QUINTA CA'.92253 (760) 771-3497 WCC: EXEMPT WC: EXEMPT 05/31/05 CSLB: 838041 05/31/06 CCC: B Permit WALL/FENCE PERMIT Additional desc Permit Fee 63.00 Plan Check Fee .00 Issue Date Valuation 3550 Qty Unit Charge Per Extension BASE FEE i, 45.00- 21.00. 9.00.00 THOU BLDG 2,001-25 1000 18.00 Special Notes and Comments: 142 L.F. 6' BLOCK WALL, ORCO SYSTEM Fee summary- Charged Paid,- Credit.e.d, Due Permit Fee Total 63.00 •.00 .00 63.00 Plan Check Total .00 .00 .00 00 Grand Total 63..00 .00 .00 63.00 • - U • , . ae� p � 200 . ' fy OP L A QUI%TA ' Ci0 Cf- 0EIN �• A e' P.O. Box 1504 VOICE (760,) 777-701 78-495 CALLE TAMPICO FAx (760) 777-7011 La QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: Architect or Engineer: 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 Code, and my Licenseyd'� ' full force and effect. �����/ icense Class % /1 cense No. OWNER -BUILDER DECLARATION I hereby affirm under penalty of pe that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business anis 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.). (, 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 pro_oerty who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , B.8 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 :o 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: Carrier 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 Califomi and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those roti ions. MrAMM WARNING: FAILURE TO SECU ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HU ED 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. 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 IMPORTANT Application is hereby made to the Director o APPLICANT ACKNOWLEDGEMENT 1. Each person upon whose behalf this application isfma ea each nd aperson at fety for a we whose reqrmit uest and to eforwhose benefit work snditions and nperfo s set frmed under or puorth on this rsuant to an 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 Ouinta, 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 perma to cancellation. 1 certify that I have read this application and state that the above information 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 county to enter uponthe above-fnentioned R 'on purposes. ate�l . O��ure (Applicant or Age 10 '< I454 If 4592 J= 1W 458.1T 45U 4W.1 A is G 642 =453.7 15:8 t 1. I � 0 100.001 +" I ...;.:- LOW. ilM R . SCG :�f�b:_.�_' Z >�:.<... �........��.'�''wi'Lr.wA..,v:,-.:w.:3htn �i�,..V�.....u....a:r;:;.�.;:>t.+'}<:,�..,..+,c2.rw..•a_.....w+;re.:ra'.',:.,rx.ir..... ..._.w.«-.F;.<,.;..u:it�a'�..s,4T;,r:.�✓..:ia:ar.:....s..,.a.-..<.i�WQr�:�Yi�.:.