04-3653 (BLCK)2 2 2004
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NM1i` °
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760) 777-7012
78-495 CALLS TAMP1Co FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number
04-00003653 Date
4/22/04
Property Address . . .
51180 AVENIDA HERRERA
APN:
773-064-008- - -
Application description'.
WALL/FENCE
Property Zoning
COVE RESIDENTIAL
..Application valuation..
1750
Owner
Contractor
------------------------
A & M BUILDERS
------------------------
A & M CONSTRUCTION
P O. BOX 1151
P.O. BOX 366
CLAREMONT CA 91711
LA QUINTA
CA 9225.3
(760) 564=4832
WCC: STATE FUND
WC: 0460009232
0.1/01/05
CSLB: 746198
02/28/06
CCC: B -C10
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Permit . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee 41.00 Plan Check Fee
.00
Issue Date
Valuation
1750
Qty Unit Charge Per
Extension
BASE FEE
15.00-
13.00 2.0000 HND BLDG 501-2,000
26.00
Speciale Notes and.Comments
70 LF 6' BLOCK WALL -CITY STANDARD.
Fee summary Charged
----------
Paid Credited
------------------------------
Due
-----------------
Permit Fee Total. 41.00
.00 .00
41..00
Plan Check Total .00
.00 .00*
.00
Grand Total 41..00
.00 .00
41.00
P.O. BOX 1504 a VOICE (760) 777-7012
78-495 CALLE TAM►ICO FAX (760) 777-7011
LA QVINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 3 Date:
Applicant: Architect or Engineer.
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby off nn under Pwl*y Of pe*xy that 1 am licensed oder provisions of Chapter 9 (commencing with Section T000) of Division 3 of to Business and Pioieasionds
LCu ms License lila 64l corse and etfeuX License No.—?Y 6 / 9 8
�h►.��C.I�s�\'
cab cantrarxor ;��r--,►� C c ►... s 1� tZ. V c_.Tt o
OWMM43UULM DECLARATION
t fiereby affirm under penalty or perjury trot 1 am onoempt from re Contractors' Stab Licence Law for the toltowiq reason (Sac. 7031.5. Business and Professions Coda: Any
city or county that requires a permit loconstruct aper. improve. derrhoist or repair any structure. prior b Its issuance. also requires the applicant forria permit b tis a signed
'staterrmaht that he or she k ioerua I Iursuant to the provisions of ria Contractors' Stab license Law (Chapior 9 (commencing with Section 7000) of Division 3 cite Busknou
and Professions Code) or that he or she is exempt lashon and the basis for tro alleged exemption. Any violation of Section 7031.5 by any applicant fa a panic subjects
the applicant to a dA penally of not mere than live hundred dottars (taco).):
U 1, as owner of the property. or my employees with wages as their sale compensaim will do the work and the structure Is not Intended or offered for sale (Sec. 7041.
Business and Professions Code: The Contractors' Stab License Law does not apply to an owner of property who bolds or improves thereon and who does to work
himself or hersell or though his or her own employees, provided that the inprovemenls are not Mended or offered ler sale. If. however. the bL4ding or inprovemenl a
sold within aro year d completion, the owner -bolder will tame the burden of proving that tie or she Lid" build or improve forte purpose of sale.).
U 1, os owner oaf fha property. am exdnaively oomtraciir g vfth:censeo contractors b construct the project (Sec. 7044. Business and Pidessions Code: The Contractors-
State license Law does not appy to an owner of property who builds or improves fheieon, and who contracts for the projects with a controcwr(s) tamest pursuant lo
one Cw*actots' State License Law.).
U I am exempt under Sec . B.3 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of to following
I have and ail maintain a certificate of consent to seff4ram ler workers' compensation, as provided for by Section 3700 of the Labor Code. ler the performance
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 ler which this permit Is
issued. My workers' oompensaion insurance carrier and policy number aoe
Carver S ►i.4TE �..,y Policy Number
. I shall not employ any person in any manner so as to became subject Its the wakets'
P0 IFS $NOW laws a Coifania, and agree that, KI should beconhe subject to the workers' compensation provisions of section 3700 of the Labor Code. I shall
fortrwwlth comply with two provisions..
Date
WARNING: FAILURE TO SECURECOIwPEN COVERAGE IS UNLAWFUL, AND SWr1LLL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED
E . DOLLARS (t/00.000). N ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR COD*flVMST. AND ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY
I hereby affirm ander penalty of/perjury that two is a construction Mn*V agency for the pedomnana of the work ler which this permit is issued (Sec. 3097. CN. C.).
Lenders Name ) ( >
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application Is hereby a*de to the Director of erupting and Safety for a permit subject to the conditions and restrictions set forth on tis application.
1. Each person upon whose behalf this appication is made. each person at whose request and for whose benefit work is performed under or pursuant b any permit
issued as a result of this application, the owner. and the applicant, each agrees to, and shall, defend. indemnify and hold hamtess the City of La Odnta. Its
officem agents and employees for any ad or omission related to the wok being performed under or following issuance of this penrit.
2 Any permit Issued as a result of this application becomes rwD and void U wok is not commenced within 160 d4Ys from date of issuarmce of such per., or
cessation of wok ler 180 days will subject permit b cancellation. •
I certify that I rave read this application and state that the above information is correct I agree lo comply with all city and county ordinances and state laws elairmp to building
construction, and hereby authorize represertatives of this county to atter upon a" -mentione
d property fa Inspection purposes.
Date 7- Signature (Applicant or Agertr `CX �. �� -C