06-2118 (BLCK)P.O. BOX 1504-
78-495
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253.
Application Number: C06,-00.0.0.2118
Property Address: 51598 VIA ROBLADA.
APN:. 772-270-010-22 .-311231- '
Application. description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2750
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT .
Owner: '
VISTA LA QUINTA PARTNERS -
223 E. DELA GUERRA.
SANTA BARBARA,- CA 93140
Contractor:
WASSERMAN CONSTRUCTION, RA
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/23/06
oQ
MAY 2 6 2006
P.O. BOX 5909
CITY OF LA QUINTA
LA QUINTn., CA 92247
FINANCE DEPT.
r�
(760)771-8191
LiC. No.: 681660
(l
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:
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
. as B License No.: 681660
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
—License
—
�peqalty
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. Nly workers' compensation-
-insurance
carrier and policy number are:hereby
affirm under 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 anystructure, 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
370 of the Labor Code, I shall fDrthwitmpl 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 (55001.:
ate:,44,plicant'
I, as owner of the property, or my employees with wages as their sole compensation, will do thework, -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 town 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 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, -
11_) 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 omissionrelated 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. -
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. I agree to comply with all -
' work for which this permit is issued (Sec. 3097, Civ. C.).
city and unty ordinances and state laws relating to building construction, and hereby authorise representatives
-
of ' co ty to er upon above-mentioned property for ins ection purpose
' Lender's Name: -
'
Date 'erg(Applicant or Agp�
Lender's Address: -
-
LQPERMIT -
'Application Number. -06-00002118
"
Permit WALL/FENCE PERMIT
Additional desc
Permit.Fee 54.00
Plan Check'Fee
„
.00
Issue Date . . .
Valuation
2750.
Expiration' Date,.. 11/1.9/06
Qty Unit,Charge Per
Extension
BASE,FEE
45.00'.
1.00 a 9.0000 THOU BLDG 2,001-25,000
9.00 '
--------------"------------------------
'Special Notes -and Comments
---------
110 L.F: 6' GARDEN WALL; ORCO SYSTEM:
Fee"summary , Charged Paid
Credited
Due
----------------- ---------- ----- ----
--------------------
�j Permit .Fee Total 54.00
-:00 .00
54.00
Plan Check Total 00
.00 "' ,.00
.00
Grand,Total 54.00
00 .00
54.00 J
-
LQPERMIT