06-2794 (BLCK)• ,
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO - J FAX (760) 777-701.1
LA QUINTA;. CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT: INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number:
06-0 —00-0-27 7 94
Property Address `"53387`VIA'
PALACIO
APN:
772-560-041- - -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL.
Application valuation:
7000
Applicant: _ �y
Architect or,,Eggineer:
Owner:
NRI CCP I
81100 AVE 53
LA QUINTA, CA 92253
Contractor:
VALLEY LANDSCAPE SERVICE
49950 JEFFERSON ST, #130.
INDIO, CA 92201
(760)674-1196
Lic. No.: 811360
Date: 7/25/06
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LICENSED CONTRACTOR'S DECLARATION
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-'' WORKER'S COMPENSATION DECLARATION
Thereby 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 Pro ssionals Code, and 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 Class: C27 d . %A, , License No.: 811360
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for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
I
issued. - l
Dater Contractor;
_ 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
E UILDER DECLARATION
Aep.4empt
'insurance carrier and policy number are: '
I hereby affirm under penalty of perjury that I from the Contractor's State License Law for the -
Carrier EXEMPT Policy Number EXEMPT
. 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 r
construct, alter; improve, demolish, or repair 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 lawsof 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 to the 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 Cod I shall fo with comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
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any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
r
Da et . Applicant: -
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
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the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COM SATION COVERAGE IS UNLAWFUL, AND SHALL'
Contractors' State License Law does not apply to anownerof 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
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improve for the purpose of sale.). -
' :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,
(_ 1 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
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of La Quinta, its officers, agents and employees for any.act or omission related to the, work being
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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
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
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation. -
certify that I have read this applicatiori 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 r insp tionpurposes.
fDate
?,.-7 _ nature-(Applicantor-Agent): ,
ti
Application Number 06-00002794
. Permit . . . : . . WALL/FENCE"PERMIT
Additional desc .
Permit Fee,, 90.00
Plan Check'Fee
.00 _•
Issue'Date
Valuation
7000
Expiration Date 1/21/07
- Qty Unit Charge Per
Extension
BASE
FEE
45.00 _ •.
5.00 9.0.000 THOU BLDG
2,001-25,000
45.00
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Special Notes and Comments
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280 L.F. 6' GARDEN WALL THROUGHOUT
-PROPERTY,•PER APPROVED SITE PLAN,
CITY_
STANDARD ..
Fee summaryCharged
Paid Credited
Due
Permit Fee Total 90.00
------- - - -
.00
- -----
00
- - - - - - -
90.00
Plan Check Total .00
.00
00
.00 ,
Grand Total 90.0,0"
1 .00
.00
-90.00
LQPERMIT