05-3878 (TT)P.O. BOX 1504
78=495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:0.5-00003878
Property Address: 45200 WASHINGTON ST
APN: 604-040-999-C -31116 -
Application description: TEMPORARY TRAILER
Property Zoning: TOURIST COMMERCIAL
Application valuation: 30000
Applicant:
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Clas : B License No.: 728102
Coate ib Contractor: Lp��%�✓if/
OWNER -BUILDER DECLARATION
I herebyaffirm under penalty of perjury that.) 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 applicantfor 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 Codel 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 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structureis 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.). -
( 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
Owner:
CA. INTELLEGENT COMM.
44139 MONTEREY AVE #210
PALM DESERT, CA 92260
r ' VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:'
LENNAR HOMES OF. CALIFORNIA I]
40004 COOK ST.
PALM -_DESERT, CA 92211
(951)817-3600
Lic. No.: 728102
------------------------------
WORKER'S COMPENSATION DEC
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.
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 AON RISK SRVC Policy Number MWC11114500'
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 laws of California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Code, 1 s- hwi t comply with those provisions.
foate: �PPlica�
WARNING: FAILURE TO.SECURE _ ORKERS' OMPE ATI FUI, AND SHALL
SUBJECT AN EMPLOYER TO CRI CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE O OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTE S , AND ATTORNEY'S FEES. -
PPLICANT 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 information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon -the above-mentioned property for in '.n'urp'oss s. '
Dai te:� ire (Applicant or Agent):
Date: 9/06/05
Application Number 05-00003878
Permit.. . . . TEMP TRAILER
/ MOBILE HOME
Additional.desc
_
Permit Fee . . . 200.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
30000
Expirat'i'on Date 3/01/06
Qty" Unit. Charge Per
Extension
BASE
FEE
200.00
Special.Notes and Comments
---------------------------------
-
TEMP SALES TRAILER PER MUP#05-565'
Fee summary Charged
Paid Credited
Due
---------- ----------
Permit Fee Total 200.00
----------
.00
----------
.00
200.00
Plan Check Total .00
.00
.00
.00
Grand Total. 200.00
.00
.00
200-00
'LQPERMTT -