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10-0108 (BLCK)P.O. BOX 1564',''VOICE (760) 777-7012 78-495 CALLE•TAMPICO FAX (760) 777-7011 LA QUINTA; CALIFORNIA 92253:: BUILDING & SAFETY DEPARTMENT. INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 2/16/10 Application Number: ^--10=00000108 Owner:. . Property Address: 47490 VIA MONTANA PALMER RESIDENCE APN: 643-120-044-272 -26152 47490 VIA MONTANA Application-description: WALL/FENCE LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 192 Contractor. D Applicant: • Architect or Engineer:' CLASSIC POOLS & SPA 79461 :AVENUE 40TH FEB1 1 BERMUDA DUNES CA 3 (760)413-4867 F-C / 2019 ff Lic. No.: 935936J` LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm underpenalty of perjury that am licensed unde provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business nd Professionals ode, 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 Class: C13-053 is se No.: 935936 - for: by Section 3700 of the Labor Code, for'the performance of the work for which this permit is r issued. Date Contractor . - _ 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 OWN -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier NATIONAL INS Policy Number • 200090117388 fallowing 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 whic 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 a 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 and agree that, if I sho Id ecome subject to t e orkers' 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 Labor Co e, shall forthwith co p1 with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by - y� any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: {V Applicant: ,.. ( ) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and -- — -- - :1 the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECU E•WORKERS' C ENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENAL S AND CIVIL FINES UP TO ONE HUNDRED 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 PROVIDED 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.). APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. ' property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ 1 I am exempt under Sec. , B.&P.C. for this reason 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. • Date: Owner. 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 • CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the _ I certify. that l have read. this application and state that the abpstrun, i correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.):, city and county ordinances and state laws relating to bu' ingnd hereby authorize representatives - of this coun t enter upon the above-mentioned proper fpo es. Lender's Name: - ,) - - t -Date: V Signature -IApplicantor-Agef+t'1�_ Lender's Address: - (` f LQPERMIT - - " :.:Application Number 10-00000108 " Permit WALL/FENCE PERMIT Additional desc . Permit Fee. 15.00 Plan Check Fee .00 Issue.. -Date Valuation 192 Expiration Date 8/15/10 Qty Unit Charge Per. Extension BASE -FEE 15.00 Special Notes.and Comments 12 LN FT.X 4 FT HT BLOCK WALL PER CITY STANDARDS & APPROVED PLANS. -----------------_-------------------------------=-------------------------- Other -Fees . . . BLDG STDS ADMIN (SB1473) -1.00 Fee summary, Charged Paid Credited Due_ Permit Fee Total 15.00 .00 .00 15.00 Plan Check Total 00 00 :00 00 Other Fee Total. 1.00 .00 .00 1.00 Grand Total 16.00 .00 .00 16.00 LQPERMIT - .