06-2619 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA (UINTA, CALIFORNIA 92253
Application Number: 06-00002619
Property Address: 53680 VIA DONA
APN: 772-420-999-29 -298944-
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
ADDlicatlon valuation: 6125
Applicant:
Tiht 4 4 Q"
Architect or Engineer:
pip
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
JEROME A. SOBA
2026 KOLL CENTER PKWY
FULLERTON, CA 92635
STE 211
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
SOBA CONSTRUCTION CO, JEROME A
7026 KOLL CNTR PRKWY, #211
PLEASANTON, CA 945F6
(925)426-3000
Lic. No.: 466537
Date: 7/10/06
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ENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of pe rj y th I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the B sine and Professionals Code, and y License is in full force and effect.
License Cla B Li se No 466 7
Date: �b O ntract
OWNER -BUILDER DECLARATION
I hereby affirm under penty perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 70 ,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 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 ($500).:
(_ 1 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 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.).
I—) 1 am exempt under Sec. , BAP.C. for this 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: NIPK
LQPERMIT
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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.
a I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, forthe pert ance of the work for which this permit is issued. My workers' compensation
insurance carrier n policy number are:
Carrier STATE FUND Policy Number 0012912-2006
,I certify that, in the pert rmance of the work for which this permit is issued, I shall not employ any
person in any_
nne so as to become subject to the workers' compensation laws of California,
and agree that, I sipuld become subje to thekers' kers' c pensation provisions of Section
X000 of the Lab ode, I shall fortuh comply rth th a provisions.
WARNING: FAILURE T6 SE RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPL ER CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0 01 ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 O E 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 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 per
2. Any permit issued as a result of this application eco s null and void if work is not commenced
within 180 days from date of issuance of such permi , or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above ' formation is correct. I agree to comply with all
city and c my ordinan��bcivearn
tlws relating to building c struction, and here authoriz representatives
of th' ou toe ter entioned properly f ' spection purpose .
Date: Tz gnature (Applicant or Agent)'
Application Number . . . . . 06-00002619
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 90.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 6125
Expiration Date 1/06/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
5.00 9.0000 THOU BLDG 2,001-25,nnn
15=00
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Special Notes and Comments
245 L.F. 6' GARDEN WALL, CITY STANDARD
Fee summary Charged Paid
---------------------------
Credited
Due
----------
Permit Fee Total 90.00
----------
.00
----------
.00
90.00
Plan Check Total .00
.00
.00
.00
Grand Total 90.00
.00
.00
90.00
LQPERMIT