04-3885 (BLCK)4
P.014� BUILDING & SAFETY DEPARTMENT
.1 ox 1504 (760),777-7012
� � J 2CO4 78�- h CALLS TAMPICO FAX (760) 777-7011
L. QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . .
04-00003885 Date
5/05/04
Property Address . . . . . .
77,9.00 DESERT DR
APN:
658-140-999-146 -29436 =
Application description
WALL/FENCE
Property Zoning . . .
LOW DENSITY RESIDENTIAL
Application valuation
650
Owner.
Contractor
TRANS WEST HOUSING
CALIFORNIA POOLS & SPAS
9968 HIBERT ST #,102
P.O. BOX 1280,.
SAN DIEGO
COACHELLA
CA 92236
SAN DIEGO CA 92131.
.(760) 398-9222
WCC: STATE FUND
F.
WC: 04600061168
01/01/05
CSLB: 656128
10/31/04
CCC: C8 -C27 -C29-053
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Permit WALL/FENCE
PERMIT ;
Additional desc
.Permit Fee 15.00
Plan Check Fee
.00
I.ssue Date . . .
Valuation . .
130
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and Comments
30 LF 5' BLOCK WALL CITY STND.
Fee summary Charged
Paid _ Credited
Due
Permit Fee Total 15.00
.00 .00
15.00
Plan.Check Total .00
.00. ..00
.00
Grand Total 15.00
.00 .00'
15.00
P.O. Box 1504 0,WVOICE (760) 77.7-7612
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 Ot INSPECTIONS (760)777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter. 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Ucenssgg,,is in full force and effect.�2 $ ,
Ucense Class L-` 5 3 LicBnse No. d
Date � Contractor
QWNER-BUILDER DECLARATION
-
I hereby affirm under penalty of pedury that I am exempt from the Contractors' 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 file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 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 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 (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 ower -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I, as ower 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 ower 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.).
U I am exempt under Sec. , BA PIC. for this reason
Date Owner_
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:.
_ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for 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 for which this permit.Is
.
IFsueQ. My wo"rs' comprisation. insurance. carrier and
any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, 11 I should becorpe"subject to the wodcers' compensation provisions•of.Section 3700.of the j abor Code, I shall
forthwith comply with those provi ns.
Date ' 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
I 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
Lender's 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.ower, and the applicant, each agrees to, and shall, defend, Indemnify and hold harmless -the City of La Quints, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit
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 informa "on 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 a r Pon the above-mentioned property for inspection purposes.
Date �� Signature (Applicant or Agent}: