07-0250 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
r7
Application Number: 0-7-=0.0-000_ 25'0
Property Address: 80175 VIA MIRPSOL r
APN: 772 -430 -010 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2750
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DON NEWMAN
80175 VIA MIRISOL
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/23/07
Contractor: 1
Applicant: Architect or Engineer: KG CONSTRUCTIO
73416 SILVER M T
PALM DESERT, C 60
('760) 275-4920 22 �oo�
Lic. No.: 819174 JP�
G1�'I OF CE I.
F1NpN
------------- - - - - -- - -•- - - - - - - - - -- - -- - - - - - - - - -
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisionsofChapter (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 will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B / Lica/NSD : 819174 for by Section 3700 of the Labor Code, for,the performance of the work for which this permit is
Y ��`�l///' issued. -
'Date Gontractoc�. ((/Uyl_.. 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 _
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 ,EXEMPT Policy Number EXEMPT'
- 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 riot employ any . r..
_ construct, alter, improve, demolish, or repair any structure, prior toits issuance, also requires the applicant for the _ person in any manner so as to become subject to the workers' compensation laws of California,
it ' - permit to file a signed. statement that he or she is licensed pursuant to the provisions of the Contractor's State and agreethat,'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 - 3700 of the Labor Code, i shall forthwith"comp - itbt/those provisions.
_1y that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
not more than five hundred dollars ($5001.: /.-"A—pplican
any applicant for a permit subjectsthe'applicant to a civil penalty of Da
(_ 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 ISec. 7044, Business and Professions Code: The < �.RN ING: 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 orherown 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.): t -� APPLICANT ACKNOWLEDGEMENT
' 1 . 1 l,' as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTTAANNT¢Apptication 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,
• I 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 Quinta, its officers, agents and employees for any act 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 - permit to cancellation.
hereby affirm under penalty of.perjury that there is a construction lending agency for the performance of the 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 county to enter upon the above-mentioned property for insp tion purposes.
Lender's Name: % -
�Da i Signature,(Applicani orAgent): �i ��
Lender's Address:_-
LQPERMIT
LQPERMIT _ r -
�. Application Number .. . . . 07-00000250
Permit . . . WALL/FENCE PERMIT
Y Additional desc
Permit Fee 99.00 Plan Check Fee
00 '
Issue•DateValuation . . .
2750
c,
Expiration Date 7/22/07
-
Qty Unit Charge Per
Extension'
BASE FEE
.90.00
1.00 ' 9.0000 THOU BLDG 2,001-25,000
9.00
-- - ---------------------------------•-----
Special Notes and Comments
--------- - - - - -- ---
110 LF 61.GARDEN WALL PER CITY
STA NDARD.INVESTIGATION FEE'ASSESSED PER
1997 UNIFORM ADMINISTRATIVE CODE §304.5
FOR WORK BEGUN WITHOUT BUILDING PERMIT.
z, '
Fee summary Charged Paid Credited, y,
P Due
;
_ 1_
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Permit Fee Total 99.00 .00 _00
99.00. :
• `
Plan Check Total 00 00 00 ,:
00
-Grand Total 99.00 00., 00
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LQPERMIT _ r -
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Q. P.O. BOX 1504
BuilAddress U ®� �S ��f C,` i y�Q r 78-495 CCALIFORNIATAMPI2
LA QUINTA, CAIORNIA 92253
L)O^ /Vi�f1/2hG
Mailing
Address
City lZip Tel
Cont r for /`/1�
S r 1.. V 014
Address
P-1 0. 60,)r
1-151/)\ J z°S 6 %_- 0
State Lic. City
& Classif. 17 Y Lic. #
Arch., Engr.,
Designer
Address Tel.
City I
Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that he 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).
❑ 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 Profes-
sions Code: The Contractor's License Law does not apply to an owner of property who builds
or improves thereon and who does such work himself or through his own employees, provided
that such improvements are not intended or offered for sale. If, however, the building or im-
provement is sold within one year of completion, the owner -builder will have the burden of
proving that he 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 Contractor's License Law does
not apply to an owner of property who builds or improves thereon, and who contracts for such
projects with a contractor(s) licensed pursuant to the Contractor's License Law)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's
Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less).
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 subject to Workers' Compensation Laws of
California.
Date Owner
NOTICE TO APPLICANT.' It, after making this Certificate of Exemption you should become
subject to the Workers' Compensation Provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the work
for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
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 hereby authorize representatives of this city to enter the above-mentioned
property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
WHITE = BUILDING DEPARTMENT
BUILDING: TYPE CONST.
A.P. Number
Legal Description
Project Description
APPLICATION ONLY
OCC. GRP.
i f
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech. .
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
YELLOW = APPLICANT PINK = FINANCE