04-3552 (BLCK)I . BUILDING &.SAFETY DEPARTMENT
w P.O. Box 1504 .' (760) 7774011
OFT19¢ 78-495 CALLS TAMPICoRAX (760) 777-7011
LA .QVINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760)-777'-7153-
BUILDING
760)777-7153BUILDING PERMIT
Application Number 04-00003552 Date 4/16/04
Property Address 47000 WASHINGTON ST
APN: 643,'200-016-. - -
Applicaton description' ". WALL/FENCE
Property Zoning CO.MMUNI_TY COMMERCIAL
Application valuation 150
Owner Contractor
LPP .INC MCDERMOTT ENTERPRISES'
PO BOX 163 P.O. BOX i63
73745 'EL :PASEO ,PALM DESERT.,CA 92261
PALM DESERT'. .CA_ '922.6.0 (760) -.346'-0.745 ..
WCC NONE
WC EXEMPT 02/28/05
CSLB 3b65.66 ': '. ..02/28/05
, .CCC B ,.. .. :
Permit WALL FENCE PERMIT
-Additional :desc `
Permit Fee . . . 15.00 Plan Check Fee .00
Issue Date " Valuation 150
Qty, Unit, Charge Per Extension
BASE FEE 15.0.0
--
Special. Notes and Comments
MONUMENT SIGN PER.:SA-2004-783
F.ee summary Charged* Paid Credited Due
:`Permit Fee. Total 15:00 0.0 '00 . .15.. 00: -
.Plan. Check Total .:. .00 , 00 :1;.'00 . 00 ..
Grand Total 15.00. 00 5:00 15:00
a �a
P.O. BOX ,1504 • �IIIJG
�IY'1 cuVO10E (760) 777-7012
78-495 CALLS TAMPICO
LA QutNTA, CALIFORNIA 92253 FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number. Oaf
Applicant:
Applicant's Mailing Address:
Date: T.' //"0
Architect or Engineer.
.Architect or Engineer's Address:
uc. No..
BUILDING PERMIT DECLARATIONS .
1 hereby affirm under LICENSED CONTRACTOR'S DECLARATION
PAY of Perjury that I am licensed under provisions of Chapter 8 (commencing with Section 7000) of Division 3 of the Business and Pnolessionats
Code. and my License is' full force and effect. License Class License No.3".6
Date /c o C X*actor
OWNER -BUILDER DECLARATION
.1 hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5. Business and Professions Code: Any
city or county that requires a Permit lo construct, alter. imProve. demolish, or repair any structure. prior to as issuance. also requires the applicant for the permit to fife a signed
statement that he or she Is licensed pursuant to Ore provisions of the Contractors' 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 Oheretrom and the basis for the alleged exempim. Any violation of Section 7031.5 by any applicant for a perp it subjects
On applicant to a civil penalty of not more than five hundred dollars (1500).):
U 1. as owner. of the property, or my employees with wages as their sole compensation,. will do the wok, and the structure is not Wended or offered for sate (Sec. 7044,
Business and Professions Code: The Contreaw state License Law does not apply to an owner of property who builds or improves thereon. and who roes the work
himself or herself or Ovough his or her own enployees, provided that the improvements are not Intended or offered for sale. ff, however. the budding or improvement is
solid within one year of coimPletion, Ore owner -Wilder will have the burden of proving that he or she did not build or improve for to purpose of sale.).
U I. as owner of.the one. 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 btAds or Improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors• State License Law).
U 1 am exempt under Sec. 64 P.C. for Ori reason
Date' owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ end will maintain a certificate of consent to seff-insure for workers' compensation. as provided for by Section 3700 of the Labor Code, for the performance
of the wok for which this Pemdt Is issued.
have and will maintain workers! compensation insurance. as required uedby Section 3700 of the Labor Code, to the performance of the wok for which this permit is
CeCarrieriss. My workers' compensation carrier and policy number are:
Number
I cer* Mat, In the perfomance of the work for which Orris permit is issued. I shad n
compensation taws of Caiomia, and a Oat• ff 1 should become Y Y person in any manner f e to become subject lo the workers'
f01 h �y with those P subject Mme work compensation provisions of Section 3700 of the Labor Code. l shad
Dafe /< d Appi=M
WARNING: FAILURE TO SECU ORKERS' COMPENSATION COVERAGE ISIfNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES LIP TO ONE HUNDRED THOUSAND DOLLARS (1100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN'
SECTION 3700 OF THE LABOR CODE, INTEREST. AND ATTORNEYS FEES. .
CONSTRUCTION LENDING AGENCY
1 hereby affirm order penalty of �cjury Oat there is a construction ler>dmg agency for the performance of the wok for which this permit is issued (Sec. 3097, Civ. C.).
lenders Name
Lender's Address' 1 -y
IMPORTANT Application is finer APPLICANT ACKNOWLEDGEMENT
eby made to the Director of Building and safety for a permit subject to the conditions and restrictions set forth on this application.
I. Each person upon whose behalf thus application is nape. each person at whose request and for whose benefit wok is performed under or pursuant to. any permit
Issued as a result of this application, the owner. and the applicant, each agrees to, and shad. defend. indemnify and hold hamdess the City of La Oulnta. 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 wok is not commenced within ISO from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
1 certify that I have read Ods application and state that the above inifonnati Is cored, I agree to comply with a y and ty ordinances and state laws relating to building
construction• and hereby authorize representatives of Bus county to anti the above nen Ins rposes.
f
Date a Signature (Applicant or
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