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BUILDING & SAFETY DEPARTMENT
P:O. Bo;x 1504
(760).777-7012
78-4CALLE T.AMptco FAX (760) 777-701.1
LAU;� TA, CALIFORNIA 9225.3 INSPECTION REQUESTS (760) 777-7153
SEP 08 1 4 IL BUILDING. PERMIT
CITV OC LA QUINTA
FINANCE DEPT.
Application Number
Property Address . . . . . .
APN:
Application description . . .
Property Zoning . . . . . .
Application valuation . . . .
04-_000.0616.1. Date
48`901 EISENHOWER DR
65"8'-130-011- - -
TEMPORARY TRAILER
LOW DENSITY RESIDENTIAL
15000
9/03/04
Owner Contractor
CENTEX HOMES CENTEX HOMES
41.865 BOARDWALK 90.1 N. GREEN VALLEY PKWY, 140
PALM'DESERT CA 92211 'HENERSON
LA QUINTA CA 92253
(702) 990-0800
WCC ZURICH AMER INS
WC: 83.2209707 1.0/01/04
CSLB: 8.25943 1.0/31/05
CCC: A -B
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Permit . . .. . . . TEMP TRAILER / MOBILE HOME
Additional desc .
Permit Fee . . . . 2.00.00 Plan Check Fee.. .00
Issue Date Valuation 15000
Qty Unit. Charge Per Extension
BASE FEE 200.00
Special Notes and Comments
TEMPORARY CONSTRUCTION TRAILER FOR
LEGACY VILLAS, T31379, PER MUP# 2004-522
Fee summary Charged Paid Credited Due
Permit Fee Total 200.00 .00 .00 200.,&0
Plan Check. Total .00 .00 .00 .00
Grand Total 200.00 .00 .00 2.00.00
P.O. BOX 1,504 • VOICE (760.) 777-7012
78-495 CALLE TAMPICO FAX (760.) 777-7011
LA QUiNTA, CALIFORNIA 9325.3 INSPECTIONS (760j 777-7153
BUILDING 8t SAFETY' DEPARTMENT
Application Number: Q q1- Date: x%'19-0
Applicant: I Architect or Engineer:
Applicants
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I 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 {WI force and eflecyf /' . � A--_• /7
OWNER43UILDER DECLARATION
thereby affix ,under penalty of pe 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 construct, alter, improve, demolish, or repair any structure, prior faits Issuance, also requires the appllcantfor the,pennit to file a signed
statement that he or she is 4licensed pursuani tD the. provisions of the. ContractDW State License Law (Chapter g (commencing with Section 7000) W Division 3 of the Business
and Professions Code) or that he or is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031:5 by any applicant for a permit. subjects
".applicant to a civil penalty of not moTwthanz five hundred dollars ($500).):
U I, as owner.of the property, or myempioyses 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 owner -builder will have the burden of proving that he or she did not build or Improve for the purpose of sale:).
U 1, as owner of the property, am exclusively contracting with lioensed 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: BA P.C. for this reason.
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under.penattyof perjury one of the foilowing declarations:
_ 1 have and will maintain a certificate of consentto seltoinsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
cof 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
issued. �Ay workers' compensation i�surence Cartier and�olicynum ria q
/tamer %G&CN /PollcyNumber GYI Z?1<��lO�
_ 1 certify that in the performance of the, rk for which ffils permit is issued, I shall not employ any person In any manner so as to become aubject to the workers'
compensation laws of Califo d greefhat If lyjmould bei subject to the workers' compensation provisions of Secdom3700 of the Labor Code, I shall
fojthwfth corrtpty with tho si ry / ' /
WARNING: FAILURE ToSEG E . ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE.HUN . THOUSAND DOLLARS ($100;000), IN ADDITIONTO THE.COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE :LABO ODE, INTEREST; AND ATTORNEY'S FEES.
. CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of pedury that there is a construction lending agency for the perfornanee of the work for which this permit is Issued,(See. 3097; Civ. C:):
Lender's Name It
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the'Director of Building and, Safety fora 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; indemnity and hold'hamnless the City of La Quinta, 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 commenoed.within 180 days -from date of Issuance of such permit, or
cesaation of work for 180 days will subject perrnit:to cancell on.
I oertity that have read this application and.state that the above info is co Ie to comply with all city and county'ordinarmoescind state laws relating to building
construction, rid ereby authorize representatives of this coun ant upon ab o tinned for Inspection purposes.
�teL Signature (Applicant or Age