05-4455 (BLCK)4 P.O. BOX 1504 ^� - VOICE (760) 777-7012
78-495 CALLE TAMPICO _ FAX (760) 7.77,7011
LA,QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS '(760) 777-7153
a - BUILDING PERMIT a
r+� Date: 10/04/05
Application Number: X0_5=0000'4'4-55 Owner:
Property Address: 80147 VIA PESSARO M/M HOUSTON
APN:' 772-550-027- - - 80147 VIA PESSARO
Application description: WALL/FENCE LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL D n
Application valuation: 2250 [rte
Contractor: OCT 0.4 1005
Applicant: Architect or -Engineer: DRURY CONSTRUCTION, MARGARE
1 73807' MASSON STREET CITY
PALM DESERT, CA 92260 FI NCEpQUINTA
(760) 346-7227 EP7
LiC. No.: 463407
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION -
- I hereby 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 Busine an ro 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: B C29 License No.: -463407 for by Section 3700 of the tabor Code, for the performance of the work for which this permit is
issued..
Date:. Contra acto �/} 'tom' _ 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 -BU R DECLARATION - - insurance carrier and.policy number are: _
I hereby affirm under penalty of perjury at I am exempt from the Contractor's State License Law for the Carrier PREFERRED INS I Policy Number WKN1157592
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 a -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 s 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 P700 of the Labor o , I shall fortwith 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 �`--rJ,. fes.
any applicant for a permit subjects the applicant to a'civil penalty of not more than five hundred dollars ($500): Date: fJ pS EApplican—t;� c ��A_A- -
( ) I, as owner of the property, or my employees with wages *as their sole compensation, will do the work, and -
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WOS' COMPENSAT N COVERAGE I1 UNLAWFUL, AND SHALL -
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,. - SUBJECT AN EMPLOYER TO CRIMINA ENALTIES 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 1$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
improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT
(•_ ) 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 contractor(s) 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, - - -
('_) 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
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. '
Date: Owner. 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 per ' , r cessatio sof work for 180 days will subject
CONSTRUCTION LENDING AGENCY - permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the - I certify that I have read this application and state that the ab v formation is correct. I agree to comply with all.
work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to buildin onstruction, and her by authorize representatives
- - of this coun .enter upon—the above=mentioned prope reinspection urpo as
Lender's Name:
�Da'7M r , �^ Signature d'APPlicant or Agent):
Lender's Address: i
iQPERMfr -
Application Number, 05-00004455
..',PermitWALL/FENCE PERMIT
Additional desc .'.
Permit -Fee 54.00 Plan Check Fee 00
Issue Date Valuation' 2250
Expiration Date 4/02/061
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG -2,001-25,000,- 9.00