05-3795 (BLCK)44Q
P.O.' BOX 1504 VOICE 760 777-7012
T ()
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA; CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
,• BUILDING PERMIT
Date: • 8/26/05
Application Number: 05-00003795 Owner:
Property Address: 80769 VIA PESSARO' JACOBSEN DAVID
APN: 772-500-069- - 353 VILLENA WAY'
Application description: WALL/FENCE PALM DESERT, CA 92260 `
Property Zoning: LOW DENSITY RESIDENTIAL + ' r
Application valuation: 5275
DContractor:
Applicant: Architect or Engine MONARCH HOMES DESERT DIV,. -INC.
AUG N 6 200" 73,290 EL PASEO, SUITE #4
'PALM DESERT; CA 92260
CITY®FLAQUINTA (760)568-3905
FINANCE 10101 Lic. No.: "457228
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LICENSED CONTRACTOR'S DECLARATION - , WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 Icommencing'with - I hereby affirm under penalty of perjury one of the following declarations:
S+
` ection 7000) of Division 3 of the Bu 'ne�Pfessionals Code, and my License is in full force and effect. ' _' I have and willmaintain a certificate of consent to self-insure for workers' compensation, as providedLicense lassrB ' ense No.: 457228 for by Section 3700 of the Labor Code, for the performance of the workfor which this permit is.• issued.
Dat ' � Contractor: �pro1y e _ 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 DILLARD INS Policy Number ' 900314
r 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 o 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 s ould become subject to the workers' com pensation 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 ode, I - all f hwith 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 • ,r^^„�O��G,,,�� -
any applicant for a. permit subjects the applicant to a civil penalty of not more than five hundred-dollars ($500).: _ Dat Applicant: �•-•"' i 1 "
F ( 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and '+� L'"�—� _ ,j - ✓
• - the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to anowner of 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.� ,�'
improve for the purpose of sale.). - APPLICANT ACKNOWLEDGEMENT - -
(_ 1 1, 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 br 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 permit, or cessation of 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 above information 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 bui ing co n, and hereby authorize representatives .
of this county to enter upon the above-mentioned grope y f nsp io r ses.
Lender's Name: ��,jy7�,O, �_.y'�.-` ` '.�� /A
V �D - ` Z"O _Signature-IApplicant or Agent):
. Lender's Address: --'_
LQPERMIT _ .
Application Number . . . . 05-00003795
Permit . . WALL/FENCE PERMIT
`
Additional desc .
Permit Fee . . . . 81.00
Plan Check Fee
.00
Issue Date
Valuation . . .
. 5275
Expiration Date 2/22/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
4.-00 9.0000 THOU BLDG
2,001-25,000
36.00 )
I
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Special Notes and Comments
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211 LF 61• BLOCK-WALL/,125 LF <3611
BLOCK
WALL.(COURTESY INSPECTION). WALLS
PER
CITY STANDARD DETAIL.'
_
Fee summary Charged
Paid-
Credited
Due
Permit Fee Total '" 81.00..
.00 ..00 _
81.00
Plan Check Total .00
:00 00
.00
Grand Total 81.00.
.00 00
81.00'.
LQPERMIT