07-1252 (BLCK)y
P.O. BOX 1504
78-495 CALLE TAMPICO
LA Q.UINTA, CALIFORNIA 92253
Application Number: L_07__00001252 --_A
Property Address: 78360 HER-ITAGE WY
APN: 643-170-999-39 -3_1348
Application description: WALL/.FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2675
WAOMM�
/ I
Applicant- Architect or Engineer:
BUILDING & SAFETY' DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTORS DECLARATION
I hereby_ affirm, under, penalty of perjury that.I am licensed under provisions of Chapter (commencing with
Section 7000) of Division-3:of the Business arid, Professionals Code; and my License is imfull force and effect.
License Class: - C27.,C8 „C29 L(cense.N6;: 849.837
Date: Contractor:
OWNER4SUILDER DECLARATION
I hereby affirm, nder,penalty of perjury that'I,am exempt from the Contractor's State License Law for the
following, 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`flle assigned statement that he or'she'is licensed pursuantto the provisions.of the Contractor's Stste
License Law (Chapter 9`(commencing with Section 7000) of'Division 3 okhe Business and Professions Code) or
that heior she is,exempttherefrom and,the basis for the alleged exemption. Any violation of Section'7031.5.by
any applicant for permit.subjects the:applicant to a civil penalty of not more'thanfive hundred dollars (8500).:
( _) I; as owner of the property; Wormy employees with wages'as their sole compensation, will. dothe'work, and
,the structure is not intended or offered for sale (Sec. 7044; Business and Professions Code: The
Contractors" State License Law does not apply to an'ownerof property who builds or improves thereon,
and who does the work himself, or herself through his or her own:employees, provided that the,
improvements are not intended or offered for sale: If„however, the building or improvememWsold within
one year of completion, the owner-builderwill'have the burden of'proving that he or she did Trot build or
improve for the purpose of.sele.).
1 1; as owner of the property, am exclusively contracting with licensed contractors.to construct'the.project (Sec.
7044,;Business and Professions Gude: rectors' State Li a Law d not apply to an owner of
property who builds or improves titer on, end wit ontrams for he o' with a contractor(s).lieensed
pursuant to'the.Conit ct `” State • -nse Law.).
(_) I am exempt under Sec. B. :C.4or this.reasoit
Date:
CONSTRUCTION LENDI G
1 hereby affirm under penalty of perjury that� here'is a construction lendig n for the performance of the
work,for which this permit is issued ISec. 3097; Civ>C.),
Lender's Name:
Lender's�Address:
V •). nI 'IYll
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/24/07
Owner!
PH RANCH LLC
78370 HIGHWAY 11.1 ST
LA QUINTA, CA 92253 D :FINANCE.
3 0 2007Contractor:
DESERT CONCEPTS LAND C �.QuIxT41800 WASHINGTON ST,; B-10!JEPT.
BERMUDA DUNES, CA 92 -- --- --
(760)200-9007
-Lic. No.: 84983.7
WORKER'S`COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of theJollowing declarations:.
I have and will maintain a:.certificate of consent to self -insure for workers' compensation, as provided
for by Sectiorr3700 of the Labor Code; for the performance of the work for which'this;permit is
issued.
I have and will maintain workers' compensatiominsurance, as required by Section 3700 of the.Labor
Code, for the performance:of the work'for whichrthis permit is issued. .My"workers' -compensation
insurance carrier and policy number are;
Carrier R DWOOD FIRE & PolicyNumber .734 4
I certify that, in.tneperformance ofithe workf - which rmit is issued, I shell not employ any
person in any manner so as to - omesu act to the rkers' compensation' California,
and agree that, if I sh me bjec to thewore ` compensation provisions of Section
3700 of the Labor C e, l It forth comply th, ose provisions.
IM4
WARNING: FAILURE TO: SECURE WORK S' COMP SATI VERAGE IS UNLAWFUL, AND;SHALL
SUBJECT AN,EMPL'OYER TO CRIMINAL PENALTIES ND CIVIL FINES UP'TO ONE HUNDRED THOUSAND
DOLLARS (6100;000). IN ADDITION To THE. COST F COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706'OF THE LABOR CODE, INTEREST; AN 'TTORNEWS FEES.
APPLICANT. ACKNO W LEDGEMENT
IMPORTANT Application is -hereby made to the Director otBuilding 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 fo, and shall defend, irxl=Ky and hold, rmI..the City
of La Quints;, its officers, agents and employees for any act or omission related to a work being
performed under or following issuance of tfiis permit.
2. Any permit issued as=s result of this application becomes null and void lf work i not commenced
within 180days from date of issuance of such pe ' sation of won 180 days willsutiject
permit to cancellation:
I certify that) have read this application and at
t the ve information is rre , ag to comply with all
city and county ordinances and state.laws lating to • d' g construction, and he b utho a representatives
of„thiscougtyto enter upon the above -me t(oned propert for inspection purposes:.
7 Sig - e(Applicantbr..Agem):
Application Number . . . . . 07-0.000.1252
Permit WALL/FENCE PERMIT
Additional desc . .
Permit. Fee 54.00
Plan Check
Fee
.00
Issue Date . . .
Valuation
. . .
. 2675_
Expiration. Date . . 10/21/07
Qty Unit Charge Per
Extension
BASE FEE'
45.-00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
---------------- ---------------Z-----------------------------------
Special Notes and Comments
107 L.F. 6' GARDEN WALL, CITY STANDARD
Fee summary Charged Paid
Credited
Due
Permit Fee Total 54..00
.00
.00
54.00
Plan Check Total .00
.00:
.00
.00
Grand Total 54.00
.00
..00
54.00
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