05-4138 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,-CALIFORNIA 92253
Application Number 05--00004 13 8----
Property Address: �" 52715 AVENIDA VILLA
APN: 773 -303 -024 -11, -000000 -
Application description: WALL/FENCE
Property Zoning: COVE RESIDENTIAL
Application Valuation: 675
Applicant:
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT. INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/15/05
Owner.
HILL JOAN
52715 AVENIDA VILLA
LA QUINTA, CA 92253
---------------------------------
Architect or Engineer: 11D
Contractor:
Owner
SEP 15 2005
CITY OF LA 2UINTA
-------------------------------- I ------------------------------------------------------------------
• 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 Business and Professionals 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: License No.:
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
. Date: Contractor:
issued.--
X 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
,
insuranc 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 40/N Policy Number
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 workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code) or
_ 3700 of the Labor Code, I shall forthwith 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
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 155001.: -
"
j Date: i . 5 Iicant:
( 1 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 ISec. 7044, Business and Professions Code: The
WARNING: FAILUREToSECURE WOR ENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner 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
(_) 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 theCity
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:R_
q � �'
2. Any permit issued as a result of this application becomes null and void ifwork is not commenced
-such
C` - -
within 180 days from date of issuance of permit, or cessation of work for 180 days will subject
_
NST TION 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 building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Lender's Name:
___
-
-
Date:!4!ni ignature (Applicant or-AgentL'- 'sM�.T� -
' Lender's Address:
ff
LQPERMIT
Application Number . . . . . 05.-00004138
_
Permit. WALL/FENCE PERMIT
Additional-desc
Permit Fee: .19.00 Plan Check Fee
00
Issue,Date. Valuation . . .
. 675
Expiration Date .. 3/14/06
Qty Unit,Charge Per
Extension . •
BASE FEE
15.00
2.00 2.0000 HNDBLDG 501-2,000
4.00
.•y----------------- =------------- ----------------------------------------------
-Special Notes and Comments
SUPPLEMENTAL TO PERMIT 05-3946 TO
REFLECT ADDITIONAL 27 LF 6' BLOCK WALL
'
ALONG CALLE NOGALES PER CITY STANDARD
Fee. summary Charged Paid Credited
Due
Permit Fee Total 19.00 .00 .00
19.00
Plan Check Total .00- .00 .00
.00
Grand Total 19.00 .00 .00
19.00
LQPERMIT