05-3924 (BLCK)r.
P.O. BOX 1504
78-495 CALLE TAMPICO
°�.• LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
05-00003924
52319 WHIRLAWAY TR
767-200-99.9-45 -312021-
WALL/FENCE
LOW DENSITY RESIDENTIAL
. 4550
Architect or E
oiN
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DESERT ELITE INC.
78401 HIGHWAY 111, SUITE G
LA QUINTA, CA 92253
(760)777-9920
VOICE (760) 777-7012
FAX (760)777-7011
INSPECTIONS (760) 777-7153
Contractor:
HERINGTON DEVELOPMENT, JAMES O
40960.CALIFORNIA OAKS RD, #283'
MURRIETA, CA 92562
(951)677-8415
Lic. No.: 753190
Date: 9/08/05
---------------- --------------------------------
------------------------------------------------—
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
• I hereby affirm under penalty of perjury a 1 am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 700 ) of vision 3 of the Busi s nd Professionals Code, 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 CI s: License No.: 753190
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
_
.ate• Q � ontractor: -
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
• OWNER -BUILDER DECLARATION
insurance carrier and olicy number are:
I hereby affirm under penalty of perju that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND A Policy Number 1542746
• following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
' _ I certify that, in the perf ma a of the work for which this permit is issued, 1 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 o 11 o become subject to the 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 sh
Id come subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
- ,3700 of _the,Labor Co
e, hall forthwith comply with those provisions.
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).:
at d •� pplicant:
,
(_) 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 sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE OR ERS' COMPENSATION 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 CRI NAL PENALTIES 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 Improvernent 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 _ 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 personat 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,
- (_) 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 applicati becomes null and void if work is not commenced
within 180 days from date'of issuance of s-- h 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 I have read this application and state that theVboinformationis correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). -
city and coo y o inances and tate laws relating to buildstruction, and hereby authorize representatives
of this coo y t enter upo eabove-mentioned propertpaction purposes.
' Lender's Name:
� � �• -
` -
ate: ignature (Applicant or Agent):
Lender's Address:
a
LQPERMIT
w
"Application Number `05-00003924
PermitWALL/FENCE PERMIT
Additional desc.. -
.. Permit Fee' 72.00
Plan Check
Fee
.00
Issue Date
'Valuation
4550
Expiration Date. 3./07/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
3.00 9.0000 THOU. BLDG 2,001-25,000
_ 27.00
- Special Notes and Comments'
182'L.F. 6' GARDEN WALL, CITY STANDARD
~
Fee -summary Charged Paid
Credited
Due' .
Permit Fee Total 72.00
.00
.00
72..00
Plan Check Total .00-.
.00.
.00
.00
Grand Total 72.00
.00-.
.00 -
- 72.00
LQPERMIT