06-2749 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00002749
Property Address:
81835 EAGLE CLAW DR
APN:
764-280-999-119 -300235-
Application description:
WALL/FENCE
Property Zoning:
MEDIUM HIGH DENSITY RES'
Application valuation:
240
Ti,ht 4 4 Qu&M
Applicant: Architect or Engineer:
Iv l
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty. of perjury that I am licensed under provisions,oUChapterS (commencing with
Section 7000) of Division 3 of the Busin&y and, Professionals Code, and my License is in full force and effect.
License class: C8 C27 C29 License'No.: 656128
ate:rxractor:
OWNER -BUILDER DECLARATION
I -hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Low 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 Section47000) of Division 3,of the Business and Professions Code) or
that,he.or�she,is'exempt therefrom andtthe basis for the; alleged exemption. Any violation of Section 7031.5'by
any applicant:fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
I _) 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 sele,(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 thatthe
improvements are not intended or offered for sale. If, however, the building or improvement isaold 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.).
(_)
[,as owner of the property; Lam exclusively contracting with licensed contractors to construct the project (Sec.
70",,Business and Professions Code: The Contractors' State.Ucense 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. , B.&P;C. for this reason -
Date: Owner:
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. CJ:
Lender's, Name:
Lender's Address:
1 K
LQPERMIT
Owner:
-HOCK
81835 EAGLE CLAW .DRIVE
LA QUINTA, CA 92253
Contractor:
CALIFORNIA POOLS &
P.O. BOX 1280
COACHELLA, CA 92236
(.760)398-9222
Lie. No.: 656.128
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/20/06
WORKER'S COMPENSATION DECLARATION
L,hereby affirm under penalty of perjury one of the following declarations:.
I 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.pertormance,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 that performance of the work for which this permit is issued, My workers' compensation
insurance carrier and policy number are:
Carrier SEABRIGHT Policy Number BB1060510
_ 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 become subject to the workers' compensation lawsof California,
and agree that, if I spould become subject to the;workers' compensation provisions of'Section
3700 of the ' bot agde, I shall forthwith comply with those provisions.
plicent:
WARNING: FAILURE TO.SECURE WO KERS' COMPENSATION COVERAGE IS UNIAWFUL,.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, DAM_AGES,AS PROVIDED FOR IN
SECTION 3706 OF THE TABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director ofBuilding.and Safety fore permit subject to the
conditions and restrictions set forth orrthis-application.
1. Each person upon whose behalf this application is made, each person at whose requestand for
whose benefit work is; performed under or pursuant -to any permit issued as a'result of this application,
'the owner, end'the applicant, each agrees to, and shall defend, indemnify and hold harmless' the City
of. La Quints,itsofficers, agents and employees for any act or omission related to thework being
performed:under or following issuancelof 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 ofwork for 180.days will subject;
permit to cancellation.
I certify that I have read this application and state that the, bove information is correct. I agree to, comply with all
city and county ordinances and state laws relating to build construction, and; hereby authorize representatives
of this cou to enter upon the above -mention inspection purposes.
Swnature (Applicant;or,Agent): -
Application Number . . . . . 06-00002749
Permit . . . .
Additional desc . .
Permit Fee . . . .
Issue.Date . . . .
Expiration Date . .
WALL/FENCE PERMIT
15.00
- 1/16/07
Plan Check Fee . . .00
Valuation . . . . 240
Qty Unit Charge Per Extension
BASE FEE 15.00
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Special Notes and Comments
15 L..F. 4' BLOCK WALL, CITY STANDARD
Fee summary Charged Paid Credited Due
----------------- -------- -- ------------------------------
Permit Fee Total 15.00 .00 .00 15.00
Plan Check Total .00 .00 .0.0 .00
Grand Total 15.00 .00 .0.0 15.00