04-5600 (BLCK)15.04
,LLE TAMPICO
A, CALIFORNIA.. 92253
BUILDING PERMIT
Property Address
APN:
Application description
Property Zoning . . . . .
Application valuation .
BUILDING & SAFETY DEPARTMENT
(760),777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760),777-71,53
04-00,005600
50620 EISENHOWER DR.
773.-370-029- -
. WALL/.FENCE
. MEDIUM DENSITY RES
7 50
Date 7/22/'04
Owner
Contractor
LANDAQ INC
LUCAS
GENERAL CONTRACTING CORP
55,920 PGF, BLVD
1.1.11
QUAIL STREET
IA .QUIN.TA. CA 9.2253
PALM
DESERT
CA 92.2'60
(909)
474-0221
WCC : •
STATE FUND.
01/'01/0'5
WC:
1714988
01/01.%05
CSLB:
75878.5
02/28/05
CCC:
B
Permit . . . . . . WALL/FENCE
PERMIT
----------------
Additional desc .
Permit Fee 21.00
Plan Check Pee
.00
,Issue Date.
Valuation
. .
750:
_ ..._ Qty- Unit Charge . Per .. _ _
_
..Extension,--
.Extension-BASE
BASE
FEE
15. .0.0
..3.00 2.0000 HND BLDG
50'1-2,000
6,00
Special Notes and Comments
2"1 LF 6' BLOCK WALL PER ORCO.DETAIL AND
APPROVED PRECISE GRADING PLAN.
Fee summary Charged
Permit Fee Total 21..00
Plan Check Total, .00
Grand Total 21.00
Paid Credited Due
.00 .00 21.0.0
..00- 00 .00 _
.00 .00 21.00
P.O. Box 1504
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0
Applicant:
C � r✓ Tn�FCT�(L
Applicant's Mailing Address:
Date: _
Architect or Engineer:
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 full force and effect.
License Class A,- License No.
Date f Contractor_ i'L' s ��� Fes/ ��
OWNER -BUILDER 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 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 Contractors' State License Law (Chapter 9 (commencing with Section 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 Shan five hundred dollars ($500).).,
U I, as owner of the property, or my employees with wages as their sole compansation, will do the work, and the structure is not intended or offered for sate (Sew 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 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 I am exempt under Sec. , B.& P.C. for this reason
WORKERS' COMPENSATION DECLARATION
hereby affirm under penalty 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 the Labor 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
,issued._My wa rs' comp tion insurance carrier and {icy numbed are:
Cartier 1. r� r Policy Humher r -5-
I certify that, in the performaribe of the work for which this permit is i sued. 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, I shall
forthwith comply with these provisions.
Date 6 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 ($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
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.).
Lenders Name
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of 13uifding and Safety for a permit subject to the conditions and restrictions set forth on Ihis 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 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 commenced within 160 days from date of issuance of such penult, or
cessation of work for 180 days will subject permit to cancellation.
I cerlfy that I have read this application and state that the above information is cored. I agree to comply with all city and county ordinances and state laws relating to bullding
construction, and hereby authorize representatives of this county to enter upon the above -mentioned property for inspection purposes.
Cate ��_. / Signature (Applicant or Agent):X