08-1223 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
68-00001223
Property Address:
47795 DUNE PALMS RD
APN:
600-020-030- -
Application description:
WALL/FENCE
Property Zoning:
REGIONAL COMMERCIAL
Application valuation:
15838
T4t!t 4 4 Q"
Applicant: Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that 1 am licensedunder provisions of Chapter 9 (commencing with
Section 7600) of`Division 3 of the BusineasavA&2fsssionals Code, and my License is in full force and effect.
LicerseC ss: .B 120
Date: ��IS V t� Contractor: _
OWNE"UILDER DECLARATION
1 hereby affirm under penalty of perjury that 1'_am exempt from the Contractor's State License Lew 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 applicant for the
permit to 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.1of,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 thanfive hundred dollars 18500).:
(_) 1, 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 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.).
(_) 1 am exempt under Sec. , 8.&P.C. forthis reason
Date:
Owner:
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:
LQPERMIT
Owner:
COACHELLA VALLEY
45701 MONROE ST
INDIO, CA 92201
Contractor:
BROWN CONSTRUCTIC
PO BOX 980700
WEST SARAMENTO, C
(916)373-93,00
Lia. No.: 396120
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/07/08
WORKER'S COMPENSATION DECLARATION
I herebyaffirm under penelty.of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self-Insure:for workers' compensation, as provided
for, by Section 3700 of the1abor Code; for the performance of the work for'which this permit is
issued.
J,; (have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
T� Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier ZURICH' AMERICAN Policy Number WC596614800
_ I certify that, in the performance of thwwork.forwhich this permit is:issued, I shall not employ any
person In any manner -so as to become subject to the Workers' compensation,liWs of California,
and agree that, if 1 should become subject to the workers' `compensation provisions,of Section
3700 of the I hwith co T 6 yrr.
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 (8100,000). IN ADDITION:TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE,.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 appiication'Is made, each personat whose request and for
whose:benefivwork.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 Le 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 H work is not commenced
within 180 days from'datwof issuance of such permit; or dation of work for 180 days will subject
permit to cancellation:
I certify that 1 have read this application and, state that the above information.is correct. Lagree.to comply with all
city and county ordinances and state laws relating to I ' uctlon, and resentatives
of this o my to,enter upon the above -men forins purp
Data:
1 Signature (Applicant or Age fl:
Application Number . . . . . 08-00001223
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 171.00 Plan Check
Fee
00
Issue Date . . . . Valuation
. . .
. 15838
Expiration Date . . 1/17/0.9
Qty Unit 'Charge Per
Extension
BASE FEE
45.00
14.00 9.0000 THOU BLDG 2,001-25,000
126.00
----------------------------- --------------------------------------------
- ------------------------------------------------------------------------
Special Notes and Comments
Special
340 IN FT X 6 FT HT TRASH ENCLOSURE; 140
LN FT X 6 FT HT ON SITE GARDEN WALL; 92
LN FT X:5 FT HT POOL & DAY CARE GARDEN
WALLS; 241 LN FT X 5 FT HT WROUGHT IRON
GARDEN WALL PER APPROVED PLANS/ .PER JJ
Fee summary Charged Paid. Credited
Due
Permit Fee Total 171.00 .00
.00
171.00
Plan Check Total .00 .00
.00
.00
Grand Total 171.00 .00
.00
171.00
LQPERMrr