05-4501 (BLCK)-
P..O..BOX 1504, . � VOICE'(760) 777.7012
78-495 CALLE TAMPICO W FAX (760) 777-7011.
LA QUINTA, CALIFORNIA 92253 BUILDING &, SAFETY DEPARTMENT ' • INSPECTIONS.(760) 777.7J53
BUILDING PERMIT "
Date:• 10/06/05
Application: Number: 0'S=0"0004501 Owner: ., ,� . - •
Property Address: -3-100. VIA VICENZE RICHARD ,ALBERS
" APN: 772-520-0.04 - ' - 53100 VIA VICENZE.'
t Application. description:WALL/FENCE,. LA QUINTA; CA 922,53 .
Property Zoning; LOW DENSITY' RESIDENTIAL
Application valuation. 7642
Contractor: OCT Applicant: Architect or Engineer. ,: . BOGART •MASONRY 0 71005
z P.O. BOX 2398 a J
YUCCA VALLEY, CA 9228 CI yOFE��I��A
s (760)250-1156 F1 "
• ; LC No. 772387,',.
.. .. ,
LICENSED CONTRACTOR'S DECLARATION = ,,.' ,.; .- '; _ WORKER'S COMPENSATION DECLARATION
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: a ,
'Section 7000) of Division 3 of the Business and Professionals Code,`and my Licenseis in.full•force and effect. - ' I have and will maintain a certificate of consent toself-insure for workers' compensation, as provided
License Class: 029_ ; - LicenseNo.:- 7723.87 - - - ^ for by Section 3700 of the Labor Code, for theperformanceof the work for which this permit is; -
issued. -
- Date: _ 'Contractor: r� _ I -have and will maintain workers' compensation insurance, asrequiredby Section 3700 of)the Labor
Code for the performance of the work for which this permit is issued. My workers' compensation
-
_ • • OWNER -BUILDER DECLARATIONi - r - -
urance 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.STAZ_}}E FUND' Policy Number 046001116305 _
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 ('.should becomesubject to the workers' compensation provisions of Section -
License Law (Chapter -9 (commencing with Section 7000) of Division 3 of the busines's and Professions Code). or +. 3700 of the Labor Code, I shall forth ith com wit a 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 ($500).:D�+gL 6 f0 �CApfilicant:'n
h 4 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and _-
-4he structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The - WARNING: FAILURE TO SECURE, WORKERS' COMPENSATIO OVERAGEIS 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 forsale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE,. INTEREST, MD ATTORNEY'S FEES:
.•i one year of completion, the owner -builder will havetheburden of proving that he or she did not build or
-� improve for the purpose of sale.). - - APPLICANT ACKNOWLEDGEMENT
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 apermit 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. I
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 r
pursuant to the Contractors' State License Law.). -' - whose benefit work is performed under or pursuant to any permitissued as a result of this application, •
f 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 -
.. .r
- of La Quinta, its officers; agents and employees for any actor omission related to the work being
performed under or following issuance of this permit. -
Date: i� `t'O -0 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
i
CONSTRUCTION LENDING AGENCY _ permit to cancellation.
I 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. -1 agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinancesand state laws relating to building construction, and hereby authorize representatives - - -
of this county to enter upon the above-mentioned property forpspec ' n p oses.
Lender's Name: (iI'//
�.` •�%�
�g
Qati. t' nature-(Applicant-o.0ge '
Lender's Address:
LQPERMIT ..
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Application Number 05-00004501
Permit WALL/FENCE.PERMIT
Additional desc,
n+
♦
Permit .Fee 99-.00 Plan Check
Fee_
x.00 _. {
,7642
Issue Date Valuation_
�.
F
Expiration Date 4/04/06
: Qty Unite Charge Per
Extension
...�
',•
BASE �
FEE
E
4500 , ,••
. .: ,
_ '
. ,
6.00 .' 9:0000 THOU .BLDG"•2,001'-25,"000 -
- -
54.00::'- y r
-
j
------------------------------ - - - - - - ------- -- - -
Special Notes .and Comments
--
-- - - - - -- -- --
'
250"LF 6' BLOCK WALL/49 LF 31 -,GARDEN
. WALL/38 LF 31X2' POOL AREA PILASTERS/4
rLF
2" SQ PILASTERS/COURTESY. INSPECTION
OF 28 LF <3611•WALL. ORCO STANDARD.
Fee summary, Charged Paid Credited
Due
rPermit Fee Total' -----99.00` ---.��-------
.00"
----99.00 i
} '+Plan
Check Total 00 00
00
00 '
Grand Total, '99.00 v .'.00
.00
.00 4 4;
99vv
u
or
LQFI RMIT