06-4081 (BLCK)ar" P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00004081
79301 SIGN OF SPRING
649-030-069-61 -31311 -
WALL/FENCE
HIGH DENSITY RESIDENTIAL
560
Architect or Engineer:
D 1A_
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
SANTA ROSA DEVELOPMENT INC
46753 ADAMS ST
LA QUINTA,,CA 92253
(760)771-3345
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/27/06
- LICENSED CONTRACTOR'S DECLARATION
1
Contractor:
MCD CONSTRUCTION49881
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
29 PALMS HIGHWAY
r_F14���
MORONGO VALLEY, CA 922-5(760)363-7740
for by Section 3.700 of the Labor Code, for the performance of the work for which this permit is
FLAQUINTA
Lic. No.: 820821
- 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 Code, 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 glass: B License No.: 820821
for by Section 3.700 of the Labor Code, for the performance of the work for which this permit is
�entractor:
issued.. -
+ _jI have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
�i.iate:
�/
C• Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
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 0442271205
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to,
I certifythat, 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 the workers' compensation provisions of Section
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
3700 of the Labor Cde�thwiwith those provisions.
a
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
at� Ap v
( ) 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
WARM G: FANHE TO SECURE WORKERS' COMPENSATION 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 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
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, 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. , BAP.C. for this reason
Date:
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:
LQPER1N11T
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application ishereby 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 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 co
ty ordinances and state laws relating to building construction, and her by authorize representatives
of. this ty to nter upon a above-mentioned property or inspection p ses.
i
ate: ignature (Applicant or Agent):
Application Number 06-00004081
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 17.00 Plan Check
Fee
.00
Issue Date Valuation
. .
560
Expiration Date 5/26/07
Qty Unit Charge Per'
Extension
BASE•FEE
15.00
1.00, 2.0000 HND BLDG 50.1-2,000
2•:00
- ---------------------------------
Special Notes and Comments
------
---------------
35 L.F. 4' PATIO/GARDEN WALL, ORCO
SYSTEM .
Fee summary Charged Paid Credited
Due
--------- ------
Permit Fee Total 17.00 .00
--- ----------
.00
17.00
Plan Check Total .00 .00
.00
.00
Grand Total 17.00 .00
.00
17.00
e
' LQPERMIT
-