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07-0701 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 07-00000701 Property Address: 53552 VIA PISA APN: 772-530-060- - Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL "rpplioation 'aaluotion: 6000 Applicant: Tiht 4 4 Q*m Architect or Engineer: ars BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: WOODREY 53552 VIA PISA LA QUINTA, CA 92253 D Contractor: RAS MASONRY INC L 1571 VIA AURORA CIRCLE CORONA, CA 92881 (760)774-0090 Lic. No.: 678140 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/07/07 MAR 0 7 2007 cavo LA ,..—_ I ------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under pr ' ions 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 ofessionals C e 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 Licen Class: C29 Lic s o.: 678140 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Date• ontractor: � �[ 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 -BUILDER 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 FUND Policy Number 0008738-2007 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, 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 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 to the we r r 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 all rthwit omply hose provisions. 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).: scant: e:r3706 (_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 00' the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARTO 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, SUBJYER 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 DOLL). 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 SECTHE 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.). (_ 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.). (_) I am exempt under Sec. , BAP.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.I. Lender's Name: Lender's Address: LQPERMIT 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 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 1 have read this application and state that the above information is correct. I a ee comply with all CA and coun y ordinances and state laws relating to buildin ction, a hereby aut or' representatives of this my to enter upon the above-mentioned propert or i ion p oses. Date: �* nature (Applicant or Agentl: Application Number . . . . . 07-00000701 Permit . . . WALL/FENCE PERMIT Additional dest . . Permit Fee . . . . 90.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . 6800 Expiration Date . . 9/03/07 Qty Unit Charge Per Extension BASE FEE 45.00 5.00 9.0000 THOU BLDG 2,001-25,000 45.00 --------------------------------------------------------------------------- Special Notes and Comments 268 L.F. 6' P/L GARDEN WALLS & 4 6' COLUMNS, ORCO SYSTEM Fee summary Charged ----------------- Paid Credited Due --------------------• Permit Fee Total 90.00 ---------- .00 ---------- .00 - 90.00 Plan Check Total .00 .00 .00 .00 Grand Total 90.00 .00 .00 90.00 LQPERMIT Bin # Permit #', O ` Project Address:' 53 A. P. Number: Legal Description: Contractor. Address: 5—zz L11,0 City, ST, Zip: AJ Telephone: State Lie. # 6% Arch., Engr., Designer: Address: (,,Tq g City, ST, Zip: Telephone: State Lic. #: Name of Contact Person: Do Telephone # of Contact Person: N Submittal 1 Plan Sets Structural Cala. Truss Cala. Energy Gla. Flood plain plan Grading. plan• Subcontactor Lift . Grant Deed ILO.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees City Of La Quints Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: d Address: 3 r City, ST, Zip: �j� Description: 5jC� 2$p/ b !fir O City Lic. # U. Construction Type: Projxt type (circle one ew Sq. Ft :. #Stories Estimated value of Projec APPLICANT: DO NOT WRITE BELOW THIS UNE Recd TRACIMG Plan Check submitted Reviewed, reidy for corrections Called Contact Person Plans Okked up Pians resubmitted 2'' Review, ready for eorrectionyusne Called Contact Person Plans picked up Plans resubmitted "RevieW, ready for.corroctions/rssat Called Contact Person Date of permit issue Omupancy: Add'n Alter Repair Demo # Units: PERMIT FEES Item Plan Check Deposit Plan Check Balance Constritedoa Mechanical Electrical Plumbing SALL Grading Developer Im2act Fee A.LP.P. Total Permit tees Amount .