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04-5463 (BLCK)APPlica0ti BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 UA 11 QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 wi� BUILDING PERMIT 11, '`lel 1 Number (04-00.005463` Date 7/14/•04 idress 51295 -CALLS HUENEME. - 770-163-.015-3 -000000 plication description WALL/FENCE Property Zoning . . . . . . . MEDIUM DENSITY RES Application valuation.. 6250 Owner Contractor ---------------- POWER FINANCE FINANCE ----------------------- CONTEMPORARY HOMES INCORP .P.O.. BOX 134 P.O. BOX 1141 LA QUINTA CA 92253 LA QUINTA CA 92253 WCC: STATE FUND WC: 16764082004 07/01/0.5 CSLB: 736920 03/31/05 CCC: B Permit WALL/FENCE PERMIT -- - - - - - - - - - - - - - - - - Additional desc Permit Fee . . . . 90.00 Plan Check Fee .00 Issue Date Valuation 6250 Qty :Unit Charge Per Extension BASE FEE 45.00 5.00 9.0000 THOU BLDG 21001-25,000 45.00 Special Notes. and Comments: -------------------- ------------- 250 LF 6' BLOCK WALL PER CITY STANDARD.FRONT PROPERTY LINE WALLS LIMITED TO MAX HEIGHT OF 5' AT P/L AND FIRST 10' BACK. Fee summary Charged Paid 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_ t P.O. BOX 1504 • 'GC��� 78-495 CALLS TAMPIt.O LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing A Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7-1 Architect or Engineer's Address: Lic. No. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 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 ClasB License No. Date Contractor OWNER -BUILDER DECLARATION I hereby affirm under 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 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).): C-) 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 of 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, .pro ' that improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder ave th an of proving that he or she did not build or improve for the purpose of sale.). t, as owner of the property, am exclusively contra with lice con ors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law do��r e�of prope ho builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' StateU I am exempt under Sec. ason Date ( owr .WORKERS' COMPEN DECLARATION 1 hereby affirm under penalty of perjury one of the following d clarations: _ I have and will maintain a certificate of consent to nsn or workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work br which this permit is issued. I have and will maintain workers' compEEF �geui by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'compensation anber are: Cartier I certify that, in theperformanc a work for which this unit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of C mia, and agree that, if I ould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, l shall forthwith comply wi ose provisions. Date 7 " 'O WARNING: FAILURE TO SECURE WORKERS' klJ PENSAT ON 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 COMP �p�AfiIOTI, DAMAGES AS PROVIDED FOR IN . SECTION 3706 OF THE LABOR CODE, INTEREST, AND A11rORNEYS FEES. \CONSTRUCIMN-LEN61NG AGENCY I hereby affirm under penalty of perjury that there is a construction len agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. CJ. Lender's Name Lender's Address . APPLICANT ACKNOWLEDGEME IMPORTANT Application is hereby made to the Director of Building and Safety for a permii s�+�1 o the conditions an stric ions set forth on this application. 1. Each person upon whose behalf this application is made, each pe t WFiosa request and for whose nefiI work is performed under or pursuant to any permit issued as a result of this application, the owner, anjd the anit nt, each agrees to, and shall, def e , indemnify and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omis ion' n related to the work being performed er or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not co nced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. certify that I have read this application and state that the above information is correctmply with all city and county ordinances and state laws relating to building construction, and hereby authorize. representatives of this county to enter upon the e�rtention property for inspection purposes. Date ! r Signature (Applicant or Agent):