04-3547 (BLCK)1.
BUILDING &.NAFETY DEPARTMENT,
P.O. Box 1504 (7.60) 7774012
C�'�OFTt�9 78-49.5: CALLS TAMPICo FAX (760) 777-70;11
LA .Q.'UINTA, CALIFORN.IA.92253 INSPECTION REQUESTS (760).777'-7153
BUILDING -PERMIT
Application Number L0_4-0.0.0.0.3547 Date 4/16/04
Property Address 47900 WASHINGTON ST
APN: '643-200-001- -
Application description WALL/FENCE
'Property Zoning COMMUNITY COMMERCIAL
Application valuation 11504
Owner Contractor .<
------------------------ - ----- ��.
EVERGREEN RTM C6MMERICAL'.''BUILDERS_INC
2920 E.'"CAMELBACK.RD #100 1300 E.'.MISSOURI AVE STE C-:100
PHOENIX, AZ 85:014 PHOENIX AZ 85.014
(602) :.263=83'00
WCC: VALLEY. INS
WC :. 0:10.30543.72.7; 07/.15/04.
CSLB:- 646842 06/30/04
CCC B.
Permit WALL/FENCE`PERMIT
Additional desc
-Permit Fee 135..00 Plan Check.Fee.'. .00
Issue Date - Valuation' 11504
Qty Unit. Charge Pere. Extension
BASE FEE
145.00
-10.0.0. 9.0000 THOU BLDG 2,001-25,000
§0. &0
,.
Special. Notes and. Comments:
71.9 LF 4PERIMETER' GARDEN BLOCK WALL,
SEE .ATTACHED GARDEN WALL STRUCTURAL:
CALCULATIONS
Fee.. summary .. Charged Paid Credited ..' Due.
Permit Fee Total 135.00 :00 00 135.00
Plan Check Total 00. ..00, :00 .00
Grand Total 7:35..00: 00 .00: 135.00
P.O. BOX u
78-495 CALLE LLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
VOICE (760) 777-7012
FAX .(760) 777-7011
INSPECTIONS (760) 777-7153
Application Number: O y' _3.5-Y- 7 I Date:
Applicant: Architect or End ear
Ste, c' AS
Apphcant s Mailing Address:
Architect or Engineers Address:
P 2
tic. No.
BUILDING PERMIT DECLARATIONS .
LICENSED CONTRACTOR'S DECLARATION
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 LJ9W is in full force and effect /
License Class �1 License No. 0J e V 2_':
OWNER-81.1I1DER DECLARATION
I hereby affirm under penalty of WX40 I am exempt tram the Contractors' State License Law for the following reason (Sec. 7031.5. Business and Professions Code: Any
city or county that a penNt 10 Conct
tu, alter, improve. demolish, or repair any structure, prior to its issuance. also requires the applicant for the permit 10 file a signed
statement that he 0 she Is icened pursuant to Ca provision of the Cordractors' State License Law (Chapter 9 (conrrrencing 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 exempliion. Any violation of Section 7031.5 by any applicant for a pemtit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U I, as owner. of the property. or my empbyees with wages as their 6040 Compensation..will do the work and the structure is not Intended or offered for We (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 or though his or her own employees, provided that the improvements are not Intended or offered for sale. If, however, the bWQing or improvement is
sold within one year of completion. the owner4older will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I. as owner of .Cie properly, am exclusively, contracting with licensed Contractors to construct the project (Sec. 7044. Business and Professions Code: The Contractors'
State License. Law does not appy to an owner of property who builds or improves Cmeieon and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State license Law.).
U I am exempt under Sec. 8.3 P.C. for this reason
r Date +F Owner .
1 hereby affirm under WORKERS' COMPENSATION DECLARATION
penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to setHrsure for workers' compensation. as provided for by Section 3700 of the Labor Code. for Cie performance
,1V of the work for which this pemdt is issued.
-I' l 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
/ • kit nation Issuance carrier and number
I
Carrier <G V_ Policy Number C I O a .S Z
_ 1 certify VOLrnthe DeAomanceof Cie work for whbh this permit is issued. l shall not employ any person in any manner so as to become subject to the workers'
compensation laws of CaRomla, and agree Cat, if 1 should become subject 10 to workers' compensation provisions of Section 3700 of the Labor Code. I shad
forthwith comply with Grose
Date
�� MPl'ca"t
WARNING: FAILURE TO SECURE W RS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100.000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE. INTEREST. AND ATTORNEYS FEES. .
CONSTRUCTION LENDING AGENCY
I hereby affirm ander penalty of perjury Cat there is a construction lending agency for the Performance of the work for which this pemdt Is issued (Sec. 3097. Civ. C.).
Lenders Name
Lenders Address
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. arty pemM
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 Le Ouinta. its
officers, agents and errhptoyees for any ad or omission related to the work being performed under or following issuancce of this permit
2. Any permit issued as a result of this application becomes null and void If work is not commenced within 160 days from date of issuance of such Pettit or
cessation of work for 180 days will subject permit to cancellation.
1 certify, that I have read this application and state that the above i tion is correct I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of thiscr>�nty to enc pon the abovetnentone� prorerty for inspection purposes.
r Date ' 7- 45 Signature (Applicant or Agent)