08-0238 (BLCK)`P=O. BOX 1504y 4XPQ
all VOICE(760) 777-7012
( )
78-495 CALLE TAMPICO r _ FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 ) BUILDING"& SAFETY DEPARTMENT INSPECTIONS (760) 777-7153,
BUILDING PERMIT }. - -
Date: 1/31/08
Application Number: �08'R00000238 Owner.
Property Address: 52-341 WHISPERING WY f DESERT ELITE, INC.
APN: 7677206-999-18 -312024- 78401 HIGHWAY 111, SUITE G _
Application description: WALL/FENCE LA QUINTA, CA 92253 Wv.1 —]
Property Zoning: LOW DENSITY RESIDENTIAL (760)777-9920 FApplication
valuation: 2000Contractor: 8 `� `� `���
Applicant: Architect or Engineer: HERINGTON DEVELOP .INC, JAMS 0-
40960 CALIFORNIA OAKS RD, 14283. CITYOFLAQUINTA
MURRIETA, CA 92562 FINANCE"!)F?7.
(951) 677-8415
f'f LiC. No.: 753190
-----------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION r
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, d 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 Cla s: Licens 53190 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
=� issued.
ate: D ntractor: L/ 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- UILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier' STATE FLJND Policy Number 1542746-2007
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any -
construct, after, improve, demolish, or iepair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to 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 should become subject tote 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 Code, haft for with ply h those.provisions. -
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by �DJ _V 40 -
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: e: t1.� plicant: AZAW-
1 _ 1 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 WORKERS' 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 CRIMINAL 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 improvement 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.). r APPLICANT ACKNOWLEDGEMENT
(_ 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 contractors) licensed 1 . Each person upon whose behalf this application is made, each person at 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
r performed under or following issuance of this permit.
Date: Owner. 2. Any permit issued as a result of this application becomes null and void if work is not commenced
CONSTRUCTION LENDING AGENCY -
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
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 the above information is correct. I agree to comply "withall
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, and hereb utho jze representatives
- of, this ounty to ent upon the above-mentioned property f inspectio purpose
Lender's Name: �,,,
s}_ - ate ignature (Applicant or Agent): -
Lender's Address: '
LQPERAIIT r