04-3649 (TT)i BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
Application Number . . .
Property Address . . .
APN:
Application description
Property Zoning
.Application valuation..
BUILDING PERMIT
04-00003'649 ' Date 4/22/04
77925 DESERT DR
658-140-999-142 -29436 -
TEMPORARY TRAILER
LOW DENSITY�RESIDENTIAL
3500
Owner
Contractor
IVANHOE LA QUINTA.COVE
TRANS WEST HOUSING,
INC.
C/O R BARRY MCCOMIC
9968 HIBERT STREET,
STE #102
7.979 IVANHOE AVE STE 550
SAN DIEGO
CA 92131
LA JOLLA CA 92037
.(858) 653=3003
WCC: STATE FUND
WC: 1648813
10/01/04
CSLB.: 701039
01/31/05
'CCC: B
------------------ -------------------------------------------
Permit . . . . . . TEMP TRAILER
7
/ MOBILE HOME
--------------
Additional desc
Permit Fee 200.00
Plan Check Fee.
.00
Issue Date
Valuation
0
Expiration Date 10/22/04.
Qty Unit Charge Per
Extension
BASE
FEE
200.00
Special Notes and Comments
TEMPORARY.SALES TRAILER PER TUP
#2003-424.
Fee summary. Charged
-----------------
Paid Credited
Due..
-----------------.---
Permit Fee Total 200..00
--------------------
.00 .00
200.00
•Plan Check Total. .00
.00 .00
.00
Grand Total 200.00
.00 .00
200.00
U
MAY. 0 5 2004
CITY OF LA Q11iNtA
FINANCE DEPT.
P.O. Box 1501 • VOICE (760) 777-7012
7E-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: - 3 6y Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer.
Architect or Engineer's Address:
Lic. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby eftim under pmt*y d perjury tet 1 am ioensed under provisions d ChWW 9 (commencing wlth Section 7000) d Division 3 d to Bu*wu and Professionals
Code. and myLioerr Is in fug tome and erect.
A.L�oemae Class Pb. _ 7010 �9
r/6ate• S-.S•OFF /Centracbr //'iI.✓S ��/Yci6i►S•w4 �LNc.
OWNER41UI DER DECLARATION
I hereby affirm under penalty of perjury that 1 am arasnpt tom the Contractors' State License Law for the following reason (Sec. 7031.5. Business and Professions Coda: Any
city or county twat requires a permit to construct aper. improve, demoist>, or repair any struoA e, lxbi to Its issuance. also requires the applicant for to permit to fie a signers
'suftment rift he or she Is icerhsad pursuant to to provisions of ria CarwacbW Stab License Law (Chapter 9 (commencing with Section 7000) of Division 3 of to Bushms
and Professions Code) or VW he or she is exempt therefrom and the basis ter the &tilled exemption. Any violation of Section 7031.5 by atgr applicant for a permit subjeft
the applicant b a dyll penalty of not mono than five hundred d Ax , MMy
U 1, as owner of the property. or my enpbyeas with wages as their sob compensation, will do the work and to structure is not Woended or offered ter sale (Sec. 7W4,
Business and Professions Code: The Combscfors' State LJoense Law does not appy to an owner d property who bolds or improves thereon. and who does the work
himseff or herself or trough his or her own anpbyees, provided that the improvements are not intended or aft ter sale. It. Iwweyw the building of improvement is
sold within one year of completion, the owrre 4x*ler will have the burden of proving that he or" did not build or improve for" purpose of sale.).
U t as owner of is property. em exclusively oomtracfing with iansed contractors to consvuct to project (Sec. 7044. Business and Professions Code: The Contactors!
State License Law does not appy b an ownerof property who builds or improves teieom, and who contracts for the projects with a contracbr(s) k a r - ea pursuant b
the Contractors' stab License Law.).
U 1 am exampt under sec . B.3 P.C. for this reason
DateOwner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penally d perjury one of the **owirq declarations:
—I have and will rmimtain a certificate of consent to sell -insure for workers' compensation, as provided for by Section 3700 d the Labor Code. forte performance
d the work for which tars pen, Is issued
_ I have and will maintain workers' cainwrance, ass . eiygyuired by section 3700 d the tabor Code. for the performance d the work for which V" permll is
1camier `_itshrpd. My v�+oM1 ens' cornpen Nu
— e,B/
shah not employ any person in any mower so ss to became PA*d b tine workaW
coo. was5on Laws cf CaMomia, and agree that. V 1 should became subject b the wasters' compensation provisions of section 3700 of the Labor Code. I shall
fortnvith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (=100.000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3705 OF THE LABOR CODE. INTEREST. Mit ATTORNEY'S FEES. .
CONSTRUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that two Is a construction lending agency for the performance of the work for wfrch tris pemrlt Is Issued (Sec. 3097. Civ. C.).
Lenders Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Appicabon Is hereby made to the Director of B"M and Safety for a perm subject to to conditions and restrictions set forth on this appialim
1. Each person upon whose behalf urs application is made. each WSW at whose request and for whose benefit work is performed under or pursuant b any pem A
Issued a$ a result Of urs application, to owner. and the applicant, each agrees b. and shag, defend, indemnify and hold harmless the City of La OuInta, Its
officers. agents and empbyees for &try ad or omission retorted to the being performed under or following issuance d tpermit
is pe
2. Any pemrt iaued as o resM d urs appiation becomes nog and void is not commenced within 160 dalys from date of issuance of such pon or
cessation d work for 160 days wig subject permit to cancellation.
I certify that 1 have read this application and state that the above kd matron leg; b comply with ad city and county ordinances and state laws Walk b building
consUuction, and hereby authorize representatives of urs ooRxdy w mentioned property for inspection purposes.
_S' 5 �Si�Appficant or Agent):