06-2130 (BLCK)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 PERMIT
Date: 5/23/06.
Application Number: 06-00002130 Owner:
Property Address:. _51664 VIA ROBLADA -VISTA LA QUINTA PARTNERS,- LLC
APN: 772-2707010-24 -311231- 223 E. DE LA GUERRA
Application description: WALL/FENCE SANTA BARBARA, CA 93140
Property Zoning: LOW DENSITY RESIDENTIAL D 7a1
Application valuation: 5000
MA p'V�!
% 20 6 Contractor:
Applicant: Architect or Engin er: WASSERMAN CONSTRUCTION, . RA
P.O.BOX 5909
CIN ®F)�q
FIId�I�C� ® UINA LA QUINTA, CA 92247
(760)771-8191
Lic. No:: 681660
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 affirmunder-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 ofconsentto self-insure for workers' compensation, as'provided
License Clas B License No.: 681660 - - for. bySection'3700 of the Labor Code, for the performance of the work foi which this permit is,
issued.
tractor= - — — - I.have and will maintain workers'• compensation insurance, as required by Section 3700 of the Labor
Code, fop the performance of-the work fol 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 personinany 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 w rkers' compensation provisions of Section .
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 37 0 of the Labor Code, I sha forthwit o p ith 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 ($500).: ate• pplicant:
(_ 1 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 WAR 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 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 offeredfor 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
I—) 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 contractors) 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.). '- - - ,i 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
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. - -
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 county ordinances and state laws relating to building construction, and hereby authorize representatives
�rfs county oe rupon the above-mentioned.property spe tion purposes.Lender's Name:/� �J 2 �+ .ignature (Applicant or Agee
Lender's Address: A
LQPERMIT
Application Number. ... 06-00002130
Permit . ... WALL/FENCE 'PERMIT
Additional desc .
Permit •Fee •: 72-.00
Plan Check
Fee..
.00
Issue- Date
Valuation
,5.000
Expiration -Date 11/19/06,
Qty Unit Charge- Per.
Extension '
BASE
FEE
- 45.00
3.00 9.000'0 -THOU' BLDG
2,001-25,000
27,.00
' :Special .--------
• � pecNotes andComments ,._
-----------------
• 200 2,.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary' Charged
Paid.' Credited
Due
Permit Fee; Total=-= 72.00
.00
.00
-j200
Plan Check Total .0'0
.00
.00
.00
Grand .Total 72.00
.00
00'
72 ..00
'-. . LQPERMIT _ ..
..
-
•, , _