07-2966 (BLCK)__V
P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
07 -0000296.6 -
Property Address:
47795 DUNE PALMS RD
APN:
60A-020-0307 -.
Application description:
WALL/FENCE
Property Zoning:
REGIONAL COMMERCIAL
Application valuation:
62800
Applicant: Architect or.Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING
soot s z t+vr
v
1 hereby affirm under penalty of perjury that. ['am licensed under provisions,of 'Chapter,9, (commencing with
Section TOGO) of Division r3 of the Business and'Professionals Code; and'.my License.. is in,full-force and effect:.
License Class: B Li` No.: 396120
Date: th & Contractor:
OWNER=BUILDER: DECLARATION
I hereby affirm under penalty of perjury that I.am exempt from the Contractor's.State License Low -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'anystructure, prior to,its issuance, also requires the.applicant-for'the_
permitsto file a signed statement that;he or she is licensed pursuant -to the provisions of the Contractor's State
License Law (Chapter -9 (commencing,with Section 7000) of;Division 3 otthe BusinessandProfessions Code) or
that he•or she, is.exempt therefrom and,the basis for the alleged exemption. Any violation of Section 7031 .5.by
anyapplicant for a permit subjects the applicant to a civil penalty of'not more.than five hundred dollars ($5001.:
1—) 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:orherself through his or he,ownemployees, 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 _ 1 l,, 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 applyto 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.).
y _) I am exempt under Sec. , B.&P:C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under -penalty of perjurythat:there,is a..construction lending agency for the performance of the
workforwhich this permit is issued ISec. 3097, Civ. C.),
Lender's Name:
Lender's Address:
LQPERMTf
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/16/08
Owner:
COACHELLA VALLEY
a45701 MONROE ST
INDIO, CA 92201
HOUSING COALI
1-G
Contractor:
BROWN CONSTRUCTION., INC.
PO BOX 9.8'07'00
WEST'SARAMENTO, CA 957.98
(916)373-930,0
Lic.. No.: 396120
WORKER'S COMPENSATION' DECLARATION
I hereby affirm under penalty of perjury one of the4ollowing'declarations: .
I have and will maintain -.a certificate of consent to:se[Mnsure.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:insurence, as required by Section,3700,of the Labor
Code, for the, performance' of the work for which this permit is issued. My workers' compensation
insurance carrier 'and policy number are:
Carrier AMER INC Policy.Number 3424:477
_ I certify that, ircthe performance of the work forwhich this permit is,issuad, 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 de�1 a1»4' rthwith cam I w' : hose provisions.
Dater 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 (5100,000). IN ADDITION TO'THE'COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION3708.OF THELABORCODE; iNTEREST, AND ATTORNEY'S:FEES.
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,wany..permit issuedas aresult of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless.the City
of La Quint&, its officers, agents and employees for anyact or omission related to the work being
performed under or following issuance of this permit.
2. Anypermit'issued as result of this application becomes null and void if work isnot commenced
within'180 days from date, of,issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
l,certify thatl have read this, applicationandstate that:the above.information.is correct. I agree to comply with all
city and county ordinances andlstate laws relating to b4jWieg•eene ion„ewd-p- uthorize.representatives
,of this county to.enter upon the -above mentio ,Inspection ores.
Date;-_ %1110olt Signature, (Applicant or Agent)- — -
3
Application Number . . . . . 07-00002966
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 473.00 Plan Check
Fee
00
Issue Date . . Valuation
62.800
Expiration Date 7/14/08
Qty Unit Charge Per
Extension
BASE FEE
414.50
13.00 4.5000 THOU BLDG 50,001-100,000
58.50
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Special Notes and Comments•
PERIMETER+WELL SITE WALLS [ORCO SPEC]
WALL HEIGHTS SHALL NOT EXCEED APPROVED
SITE DEVELOPMENT REQUIREMENTS. 2001 CBC.
THIS PERMIT DOES NOT INCLUDE INTERIOR
SITE WALLS, TRASH ENCLOSURES OR MONUMENT
SIGNS.•
January 9, 2008 9:41:21 AM AORTEGA
Fee summary Charged Paid Credited
Due
---------- ----------
Permit Fee Total 473.00 .00.
----------
.00
473.00
Plan Check Total .00 .00
00
:00
Grand Total 473.00 .00
.00
473.00
LQMRMIT