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05-1747 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:05-00001747 Property Address: 53835 AVENIDA DIAZ APN: 774-151-034-4 -000000- Application description: WALL/FENCE Property Zoning: COVE RESIDENTIAL Application valuation: 1250 T-iht 4 4 Q" Applicant: Architect or Engineed W11 FIN i ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/09/05 Owner: RODRIGUEZ JESUS PLACIDO 53835 AVENIDA DIAZ LA QUINTA, CA 92253 --------------------------------- `- — Contractor: n Owner MAY1 2005 --------------------------------- CIn QF LA QUINTA 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: License No.: 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).: I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and v ` 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 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 contractorlsl licensed pursuant to the Contractors' State License Law 09 I—) I am exempt under Sec. , B.&P.C/i , ttA reason / CONATRVr10N LENDING AGENCY I hereby affirm under penalty of perjury that here is a Instruction lending agency for the performance of the work for which this permit is issued (Sec. 3 97, Civ. C.). Lender's Name: Lender's Address: LQPERMIT -------------- WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: 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. _ 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 insurance carrier and policy number are: Carrier Policy Number 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 b come subject to the workers' compensation laws of California, and agree that, if I shoul bec e o the workers' compensation provisions of Section 3700 of the Labor Co I s orthwith comply with those provisions. pplicant: WARNING: FAILURE TO SECUR WOR ER COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CR MINAL 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 infor tion is correct. I agree to comply with all city and county ordinances and state laws relating to building tru , a eby authorize representatives of this county to enter upon the above-mentioned property f i pe i purpose Bate: / ✓ nature (Applicant or Agent): Application Number . . . . . 05-00001747 Permit . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 31.00 Plan Check Fee 00 Issue Date . . . . Valuation . . . . 1250 Expiration Date . . 11/05/05 Qty Unit Charge Per Extension BASE FEE 15.00 8.00 2.0000 HND BLDG 501-2,000 16.00 ---------------------------------------------------------------------------- Special Notes and Comments 50 LF 8' GARDEN WALL Q REAR OF P/L PER ORCO DETAIL. HEIGHT OK PER ST. Fee summary Charged --------------------------- Paid Credited Due ---------- Permit Fee Total 31.00 ---------- .00 ---------- .00 31.00 Plan Check Total .00 .00 .00 .00 Grand Total 31.00 .00 .00 31.00 LQPERMff