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08-1603 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 08-00001603 Property Address: 52768 VIA DONA APN: 772-410-999-6 -2`38944- Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Nppiicatiurl vaivariuri: 3464 T4:t!t 4 4 4" Applicant: Architect or Engineer: 40, . �,J X4- ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Buad e and Professionals Code, and my License is in full force and effect. Licensee Cl s1sQ 0 . censeN91 506667 Date: 1 1 1 D Contractor: 1 i OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 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 1, 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.). (_ 1 1, 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 am exempt under Sec. , B.&P.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: LQPER111IT Owner: WOODARD RESIDENCE 52768 VIA DCA�2S LA'QUINTA, ( , Contractor: CLARK JR, JACK 51220 AVENIDA C LA QUINTA, CA 922 (760)564-3511 Lic. No.: 506667 VOICE (760) 777-7012 FAX (760) 777-7011 PECTIONS (760) 777-7153 ------------------ WORKER'S COMPENSATION DECLARATION Date: 9/19/08 I 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 workers' compensation insurance carrier and policy number are: Carrier EXEMPT Policy Number EXEMPT _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any mann o s to become subject to the workers' compensation laws of California, and agree that, if I s o I ecome subject to the workers' compensation provisions of Section x,3/7900 of the Labor C I shall forthwith co ��/{it�h th a provisions. .Date: t/17 App licant:1C.P 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 1$100,0001. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE 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 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 certify that I have read this application and state that he a ove information is correct. I agree to comply with all city and county ordinances and state laws relating to di construction, a hereby authorize representatives of this cou y to/enter upon the above-mentioned prop f r inspection pu os Date:—�ignature (Applicant or Agent): lu LQPERMIT Application Number . . . . . 08-00001603 Permit . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 63.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 3464 Expiration Date 3/18/09 Qty Unit Charge Per BASE FEE 2.00 9.0000 THOU BLDG 2,001-25,000 _----_-- Special Notes and Comments 160 LN FT X 5FT HT BLOCK WALL, 200 LN FT X 3 FT HT BLOCK WALL PER CITY STANDARDS & APPROVED PLANS. Extension 45.00 18.00 ----------------------- ;-- Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 63.00 .00 .00 63.00 Plan Check Total .00 .00 .00 .00 Grand Total 63.00 .00 .00 63.00 Bin # Permit # Project Address: a A. P. Number: Legal Description: Contractor: Address: City, ST, Zip: Telephone: S State Lic. # Arch., Engr., Designer: Address: 8vf Q 1 City, ST, Zip: Telephone: 7?� State Lic. #: Name of Contact Person: Telephone # of Contact Person: # I Submittal 3 Plan Sets Structural Calcs. Truss Cales. Energy Cales. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees City of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: Address: O . Q City, ST, Zip: L q v Telephone: -1 eAf0 PrDescription: I Pi 3 O` WA,Lt_s u CITI I STx44 §4tb City Lic. #: t D - �� Total Permit Fees Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Stories: # Units: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE Ree'd TRACKING PERMIT FEES Plan Check submitted Item Amount Reviewed, ready for corrections Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical 2" Review, ready for corrections/issue Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading ''" Review, ready for correctionsfissue Developer Impact Fee Called Contact Person A.LP.P. Date of permit issue Total Permit Fees i � _i �l�l