04-5597 (BLCK)x 1504
CALLE TAMPICO
4TA, CALIFORNIA 92253
BUILDING PERMIT
er . . .
Property Address . . . .
APN:
Application description .
Property Zoning . . . . .
AppiicatiQn valuation .. .
BUILDING & SAFETY DEPARTMENT
(760):777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
04-0:000.5597
5.0620 EISENHOWER DR
773-370-029- -
WALL/FENCE
. MEDIUM DENSITY RES
7225
Date 7/23/04
Owner
Contractor
.00
LANDAQ INC
LUCAS -GENERAL CONTRACTING CORP
55920 PGA BLVD
1,111 QUAIL STREET
151.50
LA QUINTA CA 92253
PALM 'DESERT
CA 92260 -
(909) 474-0.221
WCC: STATE FUND
01/0'1/0.5
WC.: 171498'8
01/01/05
CSLB: 758785
02/28/0.5
CCC: B
Permit. . . . . . . WALL/FENCE PERMIT
---
.Additional de_sc . .
Permit Fee 99.0.0
P1an,Check Fee
.00
Issue.Date . . . .
Valuation . . . .
7225
Qty Unit Charge Per
Extension
BASE FEE
45.00
6. 0.0 9.0.000 THOU BLDG 2,001-2.5,000
54.00
Special,Not.es and Comments
289 LF RETAINING WALL PER APPROVED
STRUCTURAL CALCS AND APPROVED PRECISE
GRADING PLAN
Other Fees . .. . . . . . . . HOURLY
PLAN CHECK
52.50
Fee. summary Charged
Permit Fee Total 99.40
Plan Check Total .0.0
Other Fee Total 52.50
Grand Total 1:51.50
Paid
.00
.00
.00
.00
Credited Due
.40
99.00
.00
.00
.00
52.50
.00
151.50
P.O. BOX 1504 • VOICE (760) 777-70.12
78-495 CALLS TAMPICO FAX (760.) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 04' SS 7 Date: - o�
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
tX
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 Seddon 7000) of Division 3 of the Business and Professionals
Coda, and my License is in full forewand effect. -7.5-Y 7
License Class License No.
Date ®Z/dvContractor.
OWNER43UILDER DECLARATION
1 hereby affirm under penalty of perjury 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 permitto 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 sheds licensed pursuant.to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Seddon 7000) of Division 3 of 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 than five hundred dollars ($560).)-
U 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 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 ofsale.).
U I, as ownerof 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 I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby afirnunder penaltyofpedury 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 the Labor Code, for the performance
of the work, for Which this permit is issued.
_ I have and will maintain workers' co pensation insurance, as required bySec lon 3700 of the Labor Code, for the performance of the work for which this permit is
fled. fu"or. ers' pen n insurance carrier an oticyy nurr�r
Carrier/ �9 /G Policy Number ��/tel `z
— 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 provisions.
Date Applicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATI N COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($i 00,000),,[N ADDITION TO, THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S 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 (Sac. 3097, Civ: C.):
Lender's Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT.Appiication,is hereby'made to the Director of Building and Safety for a permit subject to the condition&.and restrictions set forth on this application.
1. Each person uponwhose behalf this application is made, each person at whose request and for whose benefit work .Is perfomued'.under or pursuentto any permit
issued as a.resultof this application, the owner, and the applicant, each agrees to, and shad, defend, indemnity, and hold harmless the City of La 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 applicsfion,becomesnull and void if work is not commenced within 180 days from date of issuance of such pemut, or
cessation 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 oomecL I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes.
Date ! d Signature (Applicant;or Agent): -