05-0182 (BLCK)Tdf
BUILDING & SAFETY DEPARTMENT
P.O..Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)777-7153
0
D
{ JAN 2 4 2005
GiTY OF LA QUINTA
FINANG� pPPT.
BUILDING PERMIT
Application Number . .
. .05-00000182 Date
1/19/05
Property Address .
. . . 51335 CALLS KALIMA
APN:
770-166-016-4 -000000-
Application description
WALL/FENCE
Property Zoning . . . .
. . . MEDIUM DENSITY RES
Application valuation
4333
Owner
Contractor
BUFFIN WILLIAM THOMAS
- CONTEMPORARY HOMES INCORP
P 0 BOX 134
P.O. BOX 1141
LA QUINTA CA
92253 LA QUINTA
CA 92253
WCC: STATE FUND
WC: 16764082004
07/01/05
CSLB: 736920
03/31/05
CCC: B
-Permit. . . . WALL/FENCE-PERMIT-
Additional desc
Permit Fee . . . .
72.00 Plan -Check Fee
.00
Issue Date
Valuation
4333
Qty Unit Charge
Per
Extension
BASE FEE
,.•45.00
3..00 9.0000 THOU BLDG 2,001-25,000
27.00
Special Notes and Comments
130 L.F. 6' BLOCK WALL,
50 L.F. 5'
COURTYARD WALL, BOTH CITY STANDARD
Fee summary Charged Paid Credited
Due
,Permit Fee Total
72.00 .00 .00
72.00
Plan Check Total
.00 .00 .00
.00
Grand Total
72:00 .'00 .00
72.00
0
D
{ JAN 2 4 2005
GiTY OF LA QUINTA
FINANG� pPPT.
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number: CdV
Applicant:
Applicant's Mailing Address: re> w c j, ho h reo
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: �-� y• o
Architect or Engineer:
Architect or Engineer's Address:
tJ 1A
Lic. No.: -736 2` 0
ISUILIUINU ljhKMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Cod nd my License is in full force and effect.
nse Class icense No.
ro N, � • 11-/ /IrS
I herebyaffirm under ..cv�... I IWn
penalty of perjury that I am exempt from the Contractors' State License Law for the ollowing 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 he 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. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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.
1 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 1,ril carrier and ggolicy ulmbgr are:
amer olicy Number z (o ` / � Z d 0 C/,
_ 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 alifomia, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith c9mpl ^ ith those provisions.
pplicant � o (z1 P � � ( rn cJ ti
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED 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.
LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency orJthe Performance of he work for which this
permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT
IMPORTANT Application is hereby made to the Director of Buildin and Sa ett for CKNOWLEDGEt subject o the
condandset forth on this application.
1. Each person upon whose behalf this application is made, each person atw'hose request a d for whose benefit ork�ons 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 beim ed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and diY 01 is not con!
o enced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to canc n.
I certify that I have read this application and state that the abo ' ormation is correct. re ith all city and county ordinances and state laws relating to building
construction, a�Ihlerebhorize representatives of thi unty to enter upon entio property for inspection purposes.
/DateSignature (Applicant o Agent):