04-3884 (BLCK)° t�a6t%
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760),777=7012
c p 9 78:495gALLE TAMPICO FAX (760) 777-7011
LA Q NTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) "777-7153
2'0��E BUILDING�PERMIT
App�l�eato�n�.Number 0.4-00003884 Date 5/05/04
Broperty%A?d_dress . . . 77928 DESERT DR
APN:. 658-140-999-144 -29436-
Application description -WALL%FENCE
Property Zoning . LOW DENSITY RESIDENTIAL
Applicat.i.on valuation`:. 650
Owner Contractor.
TRANSWEST HOUSING 9968 HIBERT CALIFORNIA POOLS & SPAS
ST #102 P.O. BOX 1280
SAN:DIEGO COACHELLA CA 92236
SAN DIEGO CA :92131 (7.60:) 398-52.22.
WCC: STATE FUND
WC: 04600061168 0.1/01/05
CSLB: 656128: 1.0/3.1/04
CCC:. C8=C27-C29-,C53
Permit WALL/.FENCE.PERMIT
Additional desc
Permit Fee 15.00 Plan Check Fee .00
Issue Date . . . Valuation . . . . 130
Qty Unit' Charge Per Extension
BASE- FEE 15.0 0
Special Notes and Comments
30 LF 5'BLOCK-WALL-CITY STND..
Fee summary Charged Paid: Credited. Due
Permit Fee Total 15.00 00 0.0 .15.00
Plan Check Total: 00 :00 -00 ..00
Grand Total 15.00 .00-00-15.00
P.O. BOX 1504 VOICE (760) 777:7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
TA
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 License is in full force and effect ` l� 1213
License Class L-�-. $ 3 License No. &
Dale Contractor
01
OWNER -BUILDER DECLARATION
I hereby affimh under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031 .6. 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 appficard 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 3 of the Business
and Professions Co4e) 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 cM 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 tie 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 owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
(, I. 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.).
U 1 am exempt under Sec. B.d, PA. for this reason
Date Owner_..,
WORKERS' COMPENSATION DECLARATION
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 tabor 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
i�sueQ. My wor rs'�com�ensation.insurance cornier and policy _
I certify that, in the performance of the work for which this permit is Issued. I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, l shall
forthwith comply with those provlogns.
Date !1,O[— Applicant N&AG4p6-
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 ATTORNEYS 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.).
Lenders 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 Quints, Its
officers, agents and employees for any act or omission related to the work being p6domhed under or following issuance of this permit
2. Any pemhit issued as a result of this application becomes null and void If wok 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.
certify that I have read this application and state that the above info is cored I agree to comply with all city and county ordinances and state laws relating to building
constriction, and hereby authorize representatives of this county to a er pon the above --mentioned property for inspection purposes.
Oate Signature (Applicant of Agent):