06-2142 (BLCK)u�l'rlrGv '
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: " 5/24/06
Application Number: w06-0.0-0021"4^2 - O Owner:
Property Address; 51718 VIA ROBLADA d VISTA LA QUINTA PARTNERS, LLC _
APN: 772-270-010-26 311231- 223 E: DE LA.GUERRA
,A
Application description: WALL/FENCE A NTA BARBARA, CA 93140
�
Property Zoning: ' LOW DENSITY RESIDENTIAL AY
Application valuation: 3000 . a.
Contractor:
Applicant: Architect or Engineer: WASSERMAN CONSTRUCTION, RA
P.O. BOX'5909.
LA QUINTA, CA 92247
(760)771-8191
�• Lic. No.: 681660 ' r
--——------------------——----
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I herebyaffirmunder 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 700 10) of 'vision 3 of .the Business and Professionals Cod 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.Cl s: - e No.: 681660 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is .
issued.
atntractor. _ _ 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
i - - • OWNER -BUILDER DECLARATION _ insurance carrier and policy number are:
I hereby affirm under penalty of perjury that 1 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 - person in any manner so as to become subject to the workers' compensation.laws of California,
permit to file .asigned statement that he or she'is licensed pursuant to the provisions of the Contractor's State and agree that, if I should becomes ject to the ers' compensation provisions of Section _
'License Law (Chapter.9 (commencing with Section.7000) of Division 3 of the Business and Professions Code) or. 3 100 of the Labor Code, I s With 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).: at / scant:
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-offeredforsale (Sec. 7044, Business and Professions Code: The WARNING FAILURETO SECURE ORKERS' 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 ($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 orshe did not build or -
improve for the purpose of sale.). - - APPLICANT. ACKNOWLEDGEMENT
1—) I, 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,
1 1 I am exempt under "Sec. , BAP.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 acf.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 ounty ordinances and state laws relating to building construction, and hereby authorize representatives
- - of thi ounty to e r upon the above-mentioned property for inspection purposes. -
Lender s Name.
ate: , Signature (Applicant or AgentL'
Lender's Address: � - 'r � � -
LQPERMIT; .
Application _Number . . . . . 06'-00002142
Permit WALL/FENCE PERMIT
_.
Additional.desc
.. _
Permit -Fee 54.00
"
Plan Check
Fee
.00
' Issue Date
Valuation
3.000
Expiration'Date 11/20/06
' Qty Unit Charge Per
Extension
BASE FEE
.45..00
- 5.00- 9.0000 THOU" BLDG 2,003-25,000,
9.00"
---------------------------------------------
Special Notes and Comments
-------------------
120-L-.7. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid
Credited
Due
_ Permit Fee --Total 54.00
.00
:.00' M=
54.00
Plan Check Total .__00
.00
.00
.00
Grand Total 54.00
.00 ..00
5.4.00.,
LQPERMIT