06-2120 (BLCK)4
P.O. BOX 1504 ( ) VOICE 760 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253. BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153-
BUILDING
77-7153BUILDING PERMIT
Date: 5/23/06
Application Number: 06-00002120 Owner:
Property Address: 80690 VIA GLORIETA VISTA LA QUINTA PARTNERS
APN: 772-270-010-17 -311231- 223 E. DE LA GUERRA
Application description: WALL/FENCE.. SANTA -BARBARA, 'CA 93140
Property Zoning: _,.BOW DENSITYRESIDENTIAL
Application valuation `.. 2500
t
Contractor: MAY 2 6 206
Applicant:, Architect H
or Engineer: WASSERMAN CONSTRUCTION, H
P.O. BOX 5909
LA QUINTA, CA 92247 CITY OF LAQi11NT/!
(760) 771-8191 FINANCE DEPT.
Pr
Lic: No.': 681660
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
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 Codnd my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Cla ice 6€ No.: 681660 for by Section 3700 of the Labor Code,'for the performance of the work for which this permit is
i issued.
oto 8 ntractor: -Y-1 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the - 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 not employ any
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 workers' compensation provisions of Section -
License Law.(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 37 of the Labor Coderthwit com with those provisions.
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 (5500).: ate:/ plicant: -
(_) 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 WARNING: AILURE 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 1$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 tie or she did not build or
improve for the purpose of sale.). APPLICANT ACKNOWLEDGEMENT -
(_) 1, 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. -
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. -Each person upon whose behalf this application is made, each person at whose request and for
_ 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, -
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
Dater Owner:
CONSTRUCTIONLENDING AGENCY -
I hereby affirm underpenaltyof 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: '
LQPERMIT
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. - -
certify that I have read this application and state that the above, information is correct. I agree to comply with all .
cit�his
court ,ordinances and state laws relating to building construction, and hereby authorize representatives
of tonterpon the above-mentioned property f/or�inspection�purposes.
Si a (Applicant or Agentj �/�
Application Number.:'. 06-00002120
:'Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee 54•:0.0'
Plan Check
Fee:.'.
00
Issue Date
Valuation,
2500
Expiration Date 11/19/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9:00.'
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-----Special Notes and Comments
100 L.F. 6' GARDEN WALL, ORCO SYSTEM.
Fee summary Charged Paid
Credited
Due
Permit Fee Total- 5-�=.00
.00
:00
54.00
Plan Check Total 0-0
00
.00-
00
Grand Total 54.00
00
00
54.00
LQPERMIT -
-