07-1211 (BLCK)BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/19/07
Application Number: 07-00001211 Owner:
Property Address:81822 VIA SAN CLEMENTE LA QUINTA 57 ESTATES INC
APN: 764-010-008-73 -31910 78401 HWY 111 STE G
Application description: WALL/FENCE LA QUINTA, CA 92253 D
Property Zoning: LOW DENSITY RESIDENTIAL d
Application valuation: 4125 O
Contractor: Af, y
Applicant: Architect or Engineer: HERINGTON DEVELOPME ES O� 1 I �oo`
40960 CALIFORNIA OA S RD, /
MURRIETA, CA 92562 A f4A
(951) 677-8415CF EV!eq
a ' Lic- No.: 753190
1
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that 1 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 d 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 ass: B Lice o.: 75319 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
I j issued.
C ractor: �iiave 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 DECLARATIONinsurance 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 1542746-2006
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 I should become subject to the work gy ' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3 0 of the Labor Code, I shat forthwitl comply hos provisio
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).: te: .4 d'Ap nt
a:
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: FAILUR TO SECURE WORK S' COMPENSATION COVERAGE IS UN WFUL, 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.).
1 _ 11, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.).
(_) I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name: kz
Lender's Address:
LQPERMIT
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
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.
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
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building a nstruction, and he y authorize r resentatives
of this co nt t� nter upon the above-mentioned pr ope ori spec 'on purpo ,!///`/f/JI
Dat Sign a (Applicant or Agent):
ri,
LQPERMIT
Application Number . . 07-00001211
Permit . . . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 72.00 Plan Check Fee .
Issue Date . . . . Valuation . . . .
Expiration Date 10/16/07
Qty Unit Charge 'Per
BASE FEE
3.00 9.0000 THOU BLDG 2,001-25,000
u _________
Special Notes and Comments
165 L.F. 6' GARDEN WALL, ORCO SYSTE
.00
4125
Extension
45.00
27.00
Fee summary Charged Paid Credited Due
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Permit Fee Total 72.00 .00 .00 72.00
Plan Check Total .00 .00 .00 .00
Grand Total 72.00 00 .00 72.00