07-2669 (BLCK)4
�-: P.O_ BOX 1504 VOICE (760) 777-7012
7CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/03/07
Application Number: 07-00002669 Owner:
Property Address: 58615 JEREZ CORAL OPTION I
APN: 764.-200-999-6' -316813- 79295 RANCHO LA QUINTA DR
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6375
Contractor: D A
Applicant: Architect or Engineer: TD. DESERT DEVELOPM LP
P O BOX 1716 OCT 1 0 2007
LA QUINTA, CA 9224
(760)771-1941 CITY OF LA
Lic. No.: 762987 FNANCmnawrA
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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 700 of 'vision 3 of the Business an rofessionals de, 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 Cla B ice a No.: 76 7 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
nn issued.
te: o �(/ ontractor: tk 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's State License Law for the Carrier COMPWEST Policy Number CA005001482003
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, 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 r an agree that, if I should become P4l.WazLZQthe workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3/00 of the L or Code, I uai orthwith com with those pro
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): ate( Q '(/ plica iv
1—) 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNL WFUL, 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 H RED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS. OVIDED 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.).
(_) 1, 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 contractors) licensed
pursuant to the Contractors' State License Law.).
1 ) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
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:
LQPERMIT
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 orfollowing 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 ove i rmation is correct. I agree to comply with all
city and co ty dinances and state laws relatin wilding constru tion, and hereby authorize representatives
of this co ty enter upon the above-mentio property for inspect n purposes.
aH �k: S ature (Applicant o gen[I:
Application Number . . . . . 07-00002669
...Jt
Permit . . . WALL/FENCE PERMIT
a Additional desc .
Permit Fee 90.00
Plan Check
Fee
.00
-Issue Date
Valuation
. . .
. 6375
Expiration Date 3/31/08
Qty Unit Charge Per
Extension
BASE FEE
45.00
5.00 9.0000 THOU BLDG 2,001-25,000
45.00
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Special Notes and Comments
255 L.F. 6' GARDEN WALL, PROTO SYSTEM
Fee summary Charged Paid
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Credited
--------------------
Due
Permit Fee Total 90.00
.00
.00
90.00
• Plan Check Total• .00
.00
.00
.00
Grand Total 90.00
.00
.00
90.00
LQPERMIT