04-7180 (BLCK)BUILDING .& SAFETY DEPARTMENT
P.O. Box 1.504 (760),777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number �40O�fiO-�, Date 11/10/04
Property Address . . . . . . 5.1205 EISENHOWER DR
APN: 773-065=021-1.0-H00�00-
Application description WALL/FENCE
Property Zoning .. . . VILLAGE COMMERCIAL
Application valuation . 5450
Owner Contractor
MOONEY GEORGE R OWNER
7.5205 STARDUST LN
INDIAN WELLS CA 92210
Permit . . . . . .
WALL/FENCE
PERMIT
Additional.de'sc-. .
Permit Fee. . ..
81.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 5450
Qty Unit Charge
Per
Extension
BASE
FEE.
_
45. 0 0
4.00 9.0000
THOU BLDG
2,001-25,-000
�.,
36.00 "
F.ee summary Charged
Paid Credited
Due
Permit Fee Total
8.1.00
.00
.00
81.00
Plan Check Total
.00
.0'0
.00
.00
Grand -Total
81.00
.00
.00
81.0,0"
NOV
GBW Jig c. �I11tuY�13 -
FINANCE DEPT.
r
-P.O. Box 1504 •� VOICE (760) 777-7012
78-495 CALLE TAMPiCO FAX (7.60) 777-7011
LA QUiNTA,. CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0!L 71E Date: 0 -,0 Y
Applicant: I Architect or Engineer:
Applicant's. Mailing Address:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S'DECLARATION
1 hereby affirm.under penalty of perjury that t am licensed under provisions of Chapter (commencing with Section 7000) -of Division 3 of the Business and Professionals
Code, and my License is in full`k ms and effect.
License Class license No.
Date Contractor
OWNER43UILDER DECLARATION
I herebyafrin . under penalty of.pedury that I am exempt from the Contractors' State License Lawlor the following reason (Sea 7031.5, Business andProfessfons Code- Any;
dty:or county that requires a permit to construct, alter, improve, demolish, or repair any stnxture; prior.to its issuance, also requires the applicant for the perrnitto files signed
statement that he or she is licensed.pursuant to the provisions of,the Contractors' State License Law (Chapter 9 (commencing with Section 7M) of Division 3 of the Business
and Professions Code) or.that he or she is exampttheretrom and the:basis for the alleged exemption. Any vblatla► of Section 7031.5 by arty applignt for a permdt subjects
pplicant to a civil pen
not more than five.hundred dollars ):
as owner of fire property, ormy employees with wages as their sole corrrpensation, will do thevvork, and the,structure is notintended or offered for sale .71w,
Business and Professions Code: The.Contract= State.Llcense Law does not applyto an owrrer of property who builds or itrrpnoves thereon, and who does the work.
himself orherself or through his
own employees; provided,�hat'the improvements are not k>tertded or oRered'for sale. If,,tawever, the buildingor ImprovemeM,is
sold within one"year of. completion, the owner -builder wilt have the burden of proving ihat he orshe did not -build or improvefor the purpose of sale.).
U I, as owner of ft property, am exduslvely. contracting with licensed contractors to consfirct 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 contractors) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec: , BAP .. or thisireas9{r /
i WORKERS' COMPENSATION DECLARATION
I hemby_allrm;under.penaityof perjury one of the following declarations:
y ;.I have and will maintain a certificate of consent to self4nsure 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 "wperrnit is
Issued. My workers' compensation Insurance carrier'and policy number are;
Carrier Policy Number
I certify that, in'the performance of the work foridi this permit is issued, l shell not employ any person in arty manner so as.to become:sub)ed to the workers'
compensation laws of California, and a If i should became subject to the workere'.oom provisions of Section 3700 of the Labor Code, I shall
fprthwiih comply with those provisi �e ce
H,
WARNING: FAILURE TO SECURIf WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TOCRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100;000),, IN ADDITION f6 THE COST OF COMPENSATION, DAMAGES AS. PROVIDED FOR IN
SECTION3708`OFTHE LABOR CODE, INTEREST, ANDATTORNEY'S, FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the perfonrranoe of the work for which this pennft1s issued (Sec. 309T Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby'made to,the Directorof. Building and Safety for a permit.subject to the conditions and reabictionwset forth on thlwapplication.
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 Qulnta, its
officers, agents and employees for any actor 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 180 days from date of issuance of. such permit, or
cessation of work for 180 days will subject permit to cancellation
I cerfify that I have read this application and state that'the above info incorrect. I agree to comply with all city and county ordinances and state laws.relating to building
construction, and.here'byy authorize representatives of this county I er upon the above�rre . I "property for inspection purposes.
,8915� �OV/49 T ignature (Applicant or Ag ):
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OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a.
permit. Building permits are not required to be signed byproperty owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law' to put their license number on all permits for which they
apply.,
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are'subjeet
to several obligations including State and Federal income tax withholding, federal social, security taxes, worker's
compensation insurance_, disability insurance costs and unemployment -compensation contributions.
There may be financial risks,for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact. the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the. Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform .their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
.Building permits are not required to be signed by property owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in .your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so•that we can confirm that you -are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
La Quinta, CA 2N53
(760) 777= 2
:_X�*p
-7011
OWNER'S SI NATURE/DATE
PROPERTY
-� 0N- 7180
PERMIT NUMBER(s)