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05-4594 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 05-000104594 Property Address: 52815-JALISCO'� APN: 767-200-011-47' -318741- Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 10050 1 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- 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: B License No.: 352047 ate/0' .p__[ / ntractor: r ���0 � OWN -BUILDER E ECLARATIO I hereby affirm under penalty of perjury that I am exempt from the Contractor's ate License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or cou y that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, a so requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's 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).: (_ 1 1, 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 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.). (_ 1 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. , 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 Owner: TAYLOR WOODROW HOMES, INC 15 CUSHING IRVINE, CA 92618 Contractor: — TAYLOR WOODROW HOMES INC 15 CUSHING, IRVINE, CA -92618 (760)275-0598 Lic. No.: 352047 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 �1 10/14/05 ------------------ WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: _ I 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. 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 LIBERTY MUTUAL Policy Number WA76SD283614055 _ 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 California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwi ply with those provisions. ate:i6fr7ol Plicant: �� WARNING: FAILURE TO SECURE WORKERS' COM NSATION COVERAGE IS UNLAWF L. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HU RED THOUSAND DOLLARS ($100,0001 IN ADDITION TO THE COST OF COMPENSATION, DAMAG AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMEN. 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 th isa above-mentioned property for ins e ' o- arposes. Daf(Applicant or Agent): _ t LQPERMIT Application Number . . . . . 05-00004594 Permit . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 126.00 Plan Check Fee'. .00 Issue Date . . . . Valuation 10050 Expiration Date 4/12/06 Qty Unit Charge Per Extension BASE FEE 45.00 9.00 9.0000 THOU BLDG 2,001-25,000 81.00 ---------------------------------------------------------------------------- Special Notes and Comments 402 L.F. 516" PROTO II GARDEN WALLS Fee summary Charged Paid ------------------------------------- Credited -----:----- ---------- Due Permit Fee Total 126.00 .00 .00 126.00 Plan Check Total .00 .0.0 .00 .00 Grand Total 126.00 .00 .00 126.00 LQPERMIT