06-0954 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
fir Application description
Property. Zoning:
`rte Application valuation:
�j
Applicant:
A0000954 r
80349 VIA MIRP:SOL '
772-430-001-1 -29894
WALL/FENCE
LOW DENSITY RESIDENTIAI
8000
Architect or
T4ht 4 4.Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm underpenaltyof perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business nd Professionals ode, a d License is in full force and effect.
License Class: B Li se No. 25410
. D nt 'I
N R -B DER DECLARATION
I hereby affirm under penalty,of perjury at I pt o the Contractor's State License Law for the
fallowing reason (Sec. 7031 ,5, Busines and Pr essions o e: Any city or county that requires a permit to
construct, alter, improve, demolish, orr pair 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 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 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.).
( 1 I am exempt under Sec. , B.&P.C. for this reason
Com.
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
w.prk for which this permit is issued -(Sec. 3097, Civ. C.).
Lender'sName:
Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/09/06
Owner:
DON KELLEHER
80349 VIA MIRASOL
LA QUINTA, CA 92253
Contractor:
TUSCAN CANYONS DEVELOPMENT INC
P O BOX 3139
PALM DESERT, CA 92261
(760)774-7321
Lic. No.: 825410
----------------------------------------------—
WORKER'S COMPENSATION DECLARATION
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 manner so as to become suN to the or rs' compensation laws of California,
and agree -that, if I should ecome subject t the work s' mpensation provisions of Section
3700 of the Labor od , 1 II fort with ply with h provisions.
fD� ifAPP a t.'
Com— �___
WARNING: FAILURE TO SECURE RKE S 0 PE TION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI AL P_ S A CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. IN ADDITIO TO T OST O OMPENSATION, DAMAGES AS PROVIDED FOR IN
.SECTION 3706 OF THE LABOR CO E, INTEREST, AN 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-aresult 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 the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and treby tu�i ft representatives
of this county to enter upon the above-mentioned property fortinspection purpop . 11 II
Application Number 06-00000954
Permit WALL/FENCE PERMIT
Additional desc .
?a,
Permit Fee 99-.'00
Plan Check Fee <.
.00
Issue Date . .
Application Number 06-00000954
Permit WALL/FENCE PERMIT
Additional desc .
Permit Fee 99-.'00
Plan Check Fee <.
.00
Issue Date . .
Va%luation,-
8000
Expiration Date .. 9/05/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
6.00 9.0000 THOU BLDG
2,001-25,00054.00
-------------------------------------------------------------
Special Notes and Comments
320 LF 6' GARDEN WALL PER PLAN &-CITY
STANDARD.
Fee summary Charged
---------------------------
Paid Credited
Duel
------,---
Permit Fee Total 99.00
-----=-------------
'.00 ".00
99.00
Plan Check Total .00
00. .00
.00 .
Grand Total 99.00
.00 .00
99.00