05-0664 (BLCK)�� - u�rt,�cv
BUILDING & SAFETY DEPARTMENT
B-ffiB 1504 (760) 777-7012
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78-4 ALLE TAMPICO FAX (760) 777-7011
DINT _ CALIFORNIA 92253 INSPECTION. REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number 5- 0000_0_664 Date 2/24/05
Property Address . . . . . . 52770 AVENIDA VALLEJO
APN: 773-324-001-26 -000000-
Application description . . . WALL/FENCE
Property Zoning COVE RESIDENTIAL
Application valuation 3241
Owner Contractor
NEAL KEVIN OWNER
52770 AVENIDA VALLEJO -
LA QUINTA CA 92253
----------------- 7 -----------------------------------------------
Permit WALL/FENCE
PERMIT
Additional desc
Permit Fee 6.3.00
Plan Check
Fee
.00'
Issue Date . . . .
Valuation
3241
Qty Unit Charge Per
Extension
BASE
FEE
2.00 9.0000 THOU BLDG
------------------------------------------------------------------------
2,001-25,000
18.00
Special Notes and Comments
.108 LF 61 BLOCK WALL ALONG EXTERIOR
SIDEYARD/25 LF 51 BLOCK WALL.ALL
PER
ORC&STANDARD.
Fee summary Charged
Paid
Credited
Due
7 7 -------- - - - - - - - - - - -
Permit Fee Total 63.00
- - - - - -
- - - - - - - -
.00 -.00
7 - -7
63.00
.Plan Check Total .00
.00
.00
.00'
Grand Total 63.00
.00
.00
63.00
P.O. BOX 1504 •
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: j — C / Date:
Applicant:
Applicant's Mailing Mailing Address:
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 License is in full force and effect.
License Class License No.
Date Contractor
OWNER -BUILDER DECLARATION
I hereby affirm nder penalty of 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 conn that requires a permit to construct, alter, imprcve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
stateme hat 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 P fessions 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
It
licant to a civil penalty of not more than five hundred dollars ($500).):
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.).
U I am exempt under Sec. , B.& P.C. !90F reason
gates -'i —2_ 4,0 S
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 thefor which this permit is issued.
_ I have d 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
i ued. My workers' compensation insurance carrier and policy number are:
Carrier Policy Number
ify 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, I shall
��. forthwith comply with MOW
those provisions.
'cant
WARNING: FAILURE TO SECURE W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED HOUSAND 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
Lender's Address
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.
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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter upon th bove-m 'oned property for inspection purposes.
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