07-2374 (BLCK)4 P.O. BOX 1504 VOICE (760) 777-7012
h ;L 78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA.92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/22/07
Application Number: 07-00002374 Owner:
Property Address: • 47695 DANCING BUTTERFLY SANTA ROSA DEVELOPMENT INC
APN: 649-030-069-89 -31311 - 46753 ADAMS ST
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: HIGH DENSITY RESIDENTIAL (760) 771-3345
Application valuation: 192
Contractor:
Applicant: Architect or Engineer: MCD CONSTRUCTION
49881 29 PALMS HIGHWAY
MORONGO VALLEY, CA 92256
(760)363-7740
Lic. No.: 820821
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 C29 License No.: 820821
Date: Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 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, 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.).
() 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.).
(_ 1 I am exempt under Sec. , BAP.C. for this reason
ate: / ner:
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: 1 W1
LQPER 11T
WORKER'S COMing d ions: YkRA
I hereby affirm under penalty of perjury one of the following d 'ons: e
_ I have and will maintain a certificate of consent forL
com • sa i n
for by Section 3700 of the Labor Code, for thej k for which this p i
issued.
_ I have and will maintain workers' compensation in an- i oft t
Code, for the performance of the work for whi hit w�, � com
insurance carrier and policy number are: -
Carrier STATE FUND Policy Number 0
I certify that, in the performance of the work for v hicl LIQUINWploV an
person in any manner so as to become subject o the workerf:(J"MiCM.of California
and agree that, if I should become subject to th MUM. pmv,Mon
t, 3700 of the Lab ode I shall forthwith comply with those®rovisions.
5W -.cant \ �(
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.
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 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
cWth1ty
my ordinances and state laws relating to building construction, and hereby authorize representatives
ot%%��enter upon the ab -mentioned groNagjpurposes. /T�
Date: / V Si ure (Applicant or Agent): /// /
Application Number . . . . . 07-00002374
Permit . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 15.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 192
Expiration Date 2/18/08
Qty Unit Charge• Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
12 L.F. 4' GARDEN/PATIO WALL, CITY
STANDARD
Fee summary Charged Paid
-------------------------------------
Credited
--------------------
Due
Permit Fee Total 15.00
.00
.00
15.00
Plan Check Total .00
.00
.00
.00
Grand Total 15.00
.00
.00
15.00
LQPERMIT