05-3914 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
05-00003914
Property Address:
52320—WHIRUAWAY •TR
APN:
767 -200 -999 -40 -312021 -
Application description:
WALL/FENCE
Property Zoning:
LOW. DENSITY RESIDENTIAL
Application valuation:
4550
Applicant:
-----------------
I
--------- ------I hereby affirm under penalty of perjury t
Section 700Q), -of Division 3 of the Busin
Architect or Engineer:
P /A,
VOICE (760) 777-7012'
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/08/05
r
CE ED CONTRACTOR'S DECLARATION
licensed under provisions of Chapter 9 (commencing with ,
rrofessionals Code, and my License is in full force and effect.
License No.: 753190
11II 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—) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 1-1
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
irripro'vements 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.).
1 ) 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. , 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. C.).
Lender's Name: �{ "
Lender's Address:
LQPERMIT
WORKER'S COMPENSATION DECLARATION
I 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 performance of the work for which this permit is
issued.
1 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 numb are:
Carrier. STATE FUND' licy Number 1542746
certify that, in the performanof t e work for which this permit is issued, I shall not employ any
person in any manner so as o ome subject to the workers'. compensation laws of California,
a agree that, if 1 should b co subject to the workers' compensation provisions of.Section
/00 of the Labor Code, I a forthwith comply with those provisions.
WARNING FAILURE TO SECURE WORKTS COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL VIINALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,99Q1, IN AoDIT!QN TO THE CQST OF CQMPENSATIQN, 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, aril the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quints, 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 ch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t ab ve information is correct. I agree to comply with.all
city and coup
y finances and state laws relating to bu in • onstruction, and hereby authorize representatives
of this ccou y enter upon the above-mentioned prope inspection purposes.
Nate! f �� 'nature (Applicant or Agent):
Owner.
DESERT ELITE, INC.
78401 HIGHWAY 111, SUITE G
4
LA QUINTA, CA 92253
(760)777-9920
&`&
9ontractor:
Q�.
S
HERINGTON DEVELOPMENT, JAMES O
40960 CALIFORNIA OAKS RD, #283
MURRIETA, CA 92562
(951)677-8415 ,
Lic. No.: 753190
r
CE ED CONTRACTOR'S DECLARATION
licensed under provisions of Chapter 9 (commencing with ,
rrofessionals Code, and my License is in full force and effect.
License No.: 753190
11II 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—) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 1-1
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
irripro'vements 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.).
1 ) 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. , 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. C.).
Lender's Name: �{ "
Lender's Address:
LQPERMIT
WORKER'S COMPENSATION DECLARATION
I 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 performance of the work for which this permit is
issued.
1 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 numb are:
Carrier. STATE FUND' licy Number 1542746
certify that, in the performanof t e work for which this permit is issued, I shall not employ any
person in any manner so as o ome subject to the workers'. compensation laws of California,
a agree that, if 1 should b co subject to the workers' compensation provisions of.Section
/00 of the Labor Code, I a forthwith comply with those provisions.
WARNING FAILURE TO SECURE WORKTS COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL VIINALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,99Q1, IN AoDIT!QN TO THE CQST OF CQMPENSATIQN, 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, aril the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quints, 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 ch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that t ab ve information is correct. I agree to comply with.all
city and coup
y finances and state laws relating to bu in • onstruction, and hereby authorize representatives
of this ccou y enter upon the above-mentioned prope inspection purposes.
Nate! f �� 'nature (Applicant or Agent):
Application Number. 05-00003914
Permit . . . WALL/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
Fee Total 72.00
----------
.00
----------
.00
---------Permit
72.00
P1an.Check Total .00
.00
.00
.00
Grand Total 72.00
.00
.00
72-00