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05-2992 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 0 0 2"992 Property Address: 51860 VIA.ROBLADA . APN: 772 -270 -010 -28 -311231 - Application description: WALL/FENCE Property' Zoning: LOW DENSITY RESIDENTIA Application valuation: 3875 Applicant: Architect or Ej BUILDING & SAFETY DEPARTMENT BUILDING PERMIT !�D Owner: VISTA LA.QUINTA PARTNERS 223 E. DE LA GUERRA SANTA BARBARA; CA 93140 Contractor: WASSERMAN CONSTRUCTION, RA 45520 STONEBROOK COURT LA.QUINTA, CA 92253 (760)771-8191, Lic. No.:'681660 VOICE (760) 777-7012, FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/19/05 - LICENSED CONTRACTOR'S DECLARATION - _ WORKER'S COMPENSATION DECLARATION - I. hereby affirm under penalty of perjury that I.am . sed under. provisions of Chapter 9 (commencing with- 1hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business f 'onals de nd 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 ss' B. 660 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ractor: - 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. My workers' compensation. OWNER -BUILDER DECLARATION insurance carrier and policy number are: hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 0014586-2005 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 th rk 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 b ubject 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 d agree that, i I should b ject t e ' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 700 of the or Code h with t se 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 WARNING: FAILURE TO SECURE W KERS' 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 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 herebymadeto 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 permitissued 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 ve read this application and state that the above info act. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). city and cou r nances and "te laws relating to building con horize representatives of this e r upon eabove-mentioned property or - .Lender's Name: ” ate ignature (Applicant or Agent): Lender's Address: v - - LQPERMIT ,. .Application Number . . . . . 05-00002992 _ Permit WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 63.00 Plan Check Fee .00 Issue Date Valuation 3875 Expiration Date 1/15/06 Qty Unit Charge Per Extension BASE FEE 45.0,0 2.00 9.0000 THOU BLDG 2,001-25;-000 18.00 ---------------------------------- -Special Notes and Comments ------------ ------- -------------- 155 L.F. 6' GARDEN WALL, ORCO SYSTEM Fee summary Charged Paid Credited Due Permit Fee Total. 63..00 ------- �00 --- 00 - 63 .00 Plan Check Total 00 .00 .00 .00 Grand Total 63.00- .00 .00 63-.00 LQPERMIT _ -. .. ..