04-5269 (BLCK)�tf
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760) 77777012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number
--. 04-00005269 _-_- Date
6/30'/04
Property Address
==:". - 43875 GALAXY, DR
'APN:
609-480-028-1 -23773 -
Application description WALL/FENCE
Property Zoning
LOW DENSITY RESIDENTIAL
Application valuation714�
FCo't`Tactor
Owner
---------------------------------------------
_
BONAFEDE PATRICIA'M
a� ZOU�LEONARD AND SON
��
43875, GALAXY
32388 HOPI. CIRCLE
LA :QU I NTA .
C P, 2 2 5 3-�u" c • ." D PALMS
CA .92
.
Ott x(`7060 34 -
3 3346
.:.WCC:: EXEMPT
WC: EXEMPT.'
06/30/05
CSLB: 777309
.04/30/06
.
CCC:,:. C8 ..
Permit
WALL/FENCE. PERMIT
Additional desc
Permit Fee
21.00 Plan Check Fee
.00
Issue Date
Valuation
714
Qty Unit Charge
Per.:
..Extension
BASE FEE
15.00
3.00 2.0000
HND BLDG501-2,00.0
6.00
Special . Note.s .and
Comrilents
33 LF OF 51.BLOCK
WALL CITY STND ALONG
NORTH. P/L
.Pee summary..
Charged Paid Credited
Due
Permit Fee .Total
21.00. 00 .00
21.00
Plan Check Total
.00 ..00 00
.00
-Grand Total
21.00 .00 .00
21.0.0
P.O. Box 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Ol< �a (0 . Date:
App{icant: I Architect or Engineer:
Applicants Mailing Address:
Architect or Engin r' dress:
/U/"7
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and. Professionals.
Code, and my License is.in full tome and effect.
License License No. 7 7 7309
Date C'-3 D �y Contractor C��✓��— ✓g'��l�rvGv— ��"
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractors' State License law for the foQowtng reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for the permit to file a signed
statement that he or she Is Licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (comn)encing with Section 7000) of Division 3 of the Business
and Professions Code) or 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).):
U 1, as owner of the property, or my employees with wages es their sole compensation, will do the work, and the structure is not intended or offered for safe (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 does the work
himself or herself or through his or her own employees, provided that the Improvements are not intended or offered for sale. If, however, the building or improvement is
sold within 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, 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.).
.0 I am exempt under Sec. % , B.3 P.C. for this reason
Date Owner.
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penafty of perjury one of the following declarations: .
I have and will maintain a certificate of consent to selfinsure for workers' compensation, as provided for by Section 3700 of the labor Code, for the ,perfo mane "
of the work for which this permit is issued.
_ 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 insurance prier and policy number are:
Cartier Policy Number
certify that, in the performance of the work for which this pernit is issued, i shall not employ any person in any.manner so as to become subject to the workers'
compensation laws of Califorila, and agree that, If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions:
Date O moi/ Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN .
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
1 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
Lenders Address
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 tl)e work being performed under or following issuance of this peril
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 I have read this application 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 a tioned property for inspection purposes.
Date. G ^ 30 c/ Signature (Applicant or Agent): alai'
7608360447; JUN -24-04 10:17AM; PAGE 4/5
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A RE -INSPECTION FEE OF •$3 -
WI LUBE CHARGED IF THE APPROVED
PLANS AND JOB CARD. ARE NOT ON
THE SITE FOR A SCHEDULEDINZEC
NO EXCEPTIONS! '
BUILDING & SAFETY DEPT.
• APPROVED
FOR CONSTRUCTION
DATE g�