04-3504 (BLCK)BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153
BUILDING PERMIT
Application Number . . . . . 04-000.03-504 Date 4/16/04
Property Address 79827 DEREK ALAN DR
APN: 649-520-014-2 -290532-
Application description WALL/FENCE
Property Zoning . . . . . LOW DENSITY RESIDENTIAL
Application valuation 2000
Owner. Contractor
PM RENAISSANCE, LLC TRANS WEST.HOUSING,. INC..
9968 HIBERT STREET, 'STE. .102 9968 HIBERT STREET, STE #102
SAN.DIEGO CA 92131 SAN DIEGO CA 92131
(858) 653.3003
:.WCC: STATE FUND
WC: 16488.13 10/01/04
CSLB: .701,039 01/31/05
CCC: B
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 45.00 Plan Check Fee .00
Issue Date . . . . Valuation 2000
Qty Unit Charge Per Extension
BASE FEE 15.00
15.00 2.0000 HND BLDG 501-2,000 30.00
----------------------------------.-----------.------------.-------------------
Special Notes and .Comments.
80 L.F.. 6' PROPERTY LINE WALL,.bRCO
SYSTEM
Fee summary Charged Paid Credited Due
- - - - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - qF - - - - - - - -7 - - - - - - - -
Permit Fee Total 45.00 .00 .00 45.00
Plan Check Total .00 .00 .00 .00
Grand Total 45.00 .00 .00 45.00
P.O. Box 1504 VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: ' . �. �% I Date:
Applicant: Architect or Engineer.
Applicant's Mailing
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
UCENSED 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 License LRfun force and affect S '020
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OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sea 7031.5, Business and Professions Code: Any
taly or county that requires a permit to constrtrcL altar, improve, dertofish, or repair any stnrctura,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 Low (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 dial penalty of not more than five hundred dollars ($500).):
U 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 We (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 or 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.).
U I, as owner of the property, am exclusively conbaWng 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to seOwinsure 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.
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
My cemDesation n�nde carrier
_ I certify that, in the performance of the work tot which�iis permit is issued, l 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
yfortthwith.ccomply with those provisions.
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WARNING: FAILURE TO SECURE WORKERS' COOENSATION 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. .
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a constriction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address _ T>
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 pemrit
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 160 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 aut=gnatur*
es of this county to enter upon the above-mentioned property for inspection purposes.
nt or Agent): `