06-2146 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO'
LA QUINTA, CALIFORNIA 92253:
Application Number: ` 06-00002146
Property Address: 80665 VIA GLORIETA
APN: 1 1 772-270-010-40 -311231-
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 500,
Applicant:
Architect or Engi
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
0
Owner:
VISTA LA QUINTA PARTNERS
223 E. DE LA GUERRA
SANTA BARBARA, CA 93140
Contractor:
WASSERMAN CONSTRUCTION, RA
P.O. BOX 5909
LA QUINTA, CA 92247
(760)771-8191
Lic. No.: 681660
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: , 5/24/06
LQPERMIT
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t - LICENSED CONTRACTOR'S DECLARATION -
--- --------------- -------------.
WORKER'S COMPENSATION DECLARATION - 4
I hereby affirm under penalty of perjury that i am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
_ I have and willmaintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B L' seNo.: 681660
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ,
.issued..
V I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor ;
/Dater— ractor:
Code, for the performance of the work for which this permit is issued. My workers' compensation
" OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
insurance carrier and policy number are: -
Carrier STATE FUND _ Policy Number 7560000002
' following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to_
I certify that, in the performance of the work for which this permit is issued, I shall notemployany
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the -
person in any manner so as to become subject to the workers' compensation laws of California, -
' permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should become subject to the wor ers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
of the Labor Code, I shall fo ith co I th those provisions.
'that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
6 700
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:
10
ate: scant:
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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
- Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
. improvements are not intended or offered for sale. If, however, the building or improvement is sold within ,
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.)
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the -
_ 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
1 Each upon whose behalf this application is made, each person at whose request and for
property who builds or improves thereon, and who contracts for the projects with, a contractor(s) licensed
. person
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
I r 1 I am exempt under.Sec. , B.&P.C. for this reason - -
- the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
- —
'of La Ouinta, its officers, agents and employees for any as or omission related to the work being'. -
-
performed under or following issuance of this permit. '
Date: - Owner: -
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
CONSTRUCTION LENDING AGENCY - -
' I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - _
city and county ordinances and state laws relating to building construction, and hereby authorize representatives.
of this unty o en upon the above-mentioned property for inspectionpur ses. ,
Lender's Name: ► Y
-
/�
te: < ure (Applicant or Agent): .
•_
Lender's Address:
LQPERMIT
Application Number . . 06-00002146
Permit . . . WALL/FENCE-PERMIT
-
Additional;desc .
Permit Fee 15.00
Plan Check
Fee
.00
Issue -Date
Valuation
500
Expiration Date 11/20/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
Special Notes and Comments
20 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid
Credited
Due
Permit Fee Total 15.00
.00
.00
15.00
Plan Check Total 00
.00
.00
.00
Grand Total 15.00
.00
.00
15.00
LQPERMIT -