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06-1524 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06-00.001524 Property Address:. 80905 VIA SAVONA APN: 772-410-998-J -32453 - ' Application description: WALL/FENCE Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 4250 Applicant: Architect or Engineer: 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (7 777-7012 F (. 777-7011 INSP NS 77-7153 - WORKER'S. COMPENSATION DECLARATION /2 ./06 r Owner: ND LA QUINTA PARTNERS 375 N FRONT ST STE 200 COLUMBUS, OH 43215 -------------------------- Contractor: Owner 1 LQPERX11T - --------------------------------- - LIC NSED 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 License Class: License No.: _ for by Section 3700 of the Labor -Code, for the performance of the work for which this permit is - A-4 ©//iIV �L issued. - Date: Contractor: j -Al _ 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: , I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier Policy Number - 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 workers' compensation provisions of Section License Law (Chapter 9 (commencingwith Section 70001 of Division 3 of the Business and Professions Code) or 3700 o the Labor Code, I shall forthwit com I ith ose provisions. PY 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).: Date: — Applicant: 9 1 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: TheWARNING: 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 ($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 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 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 7 �/'- - performed under or following issuance of this permit. , ' '—/Date: Owner: - 2. Any permit issuedas 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 Q91 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 thi zapplicatoon 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.1.'' - cit .and county ordinanc and state laws relating to building construction, and hereb authorize representatives ' this county to enter pon the above-mentioned property for' s ti purP /this a Lender's Name: �" it - "- i Date: Signature (Applicant or Agent)' Lender's Address: - 1 LQPERX11T - Application Number .06-00001524 -•. Permit WALL/FENCE'PERMIT Additional desc Permit"Fee72.00 Plan Check Fee:. .00 . Issue Date . . . Valuation . . . . 4250 Expiration Date '. 12/20/06 Qty Unit -Charge Per Extension BASE FEE 45.'00 3.00 9.0000 THOU BLDG 2,001725,000_ 27.00 ---------------------------------------------------------- - Special'Notes and Comments retaining walls ranging from 41,511 ret." with 6' 3" garden walls on top.and 7' 111' ret. with 61:311 garden walls `on top.all per approved plans.170 total ln. ft.June 23,.2006 1:47:26 PM JJohnson Other -Fees . . HOURLY PLAN CHECK, 210.00 Fee summary. Charged Paid Credited Due Permit Fee Total 72.00 .00 .00 72.00 Plan Check Total .00 .00' .00 .00 Other Fee Total 210.00 .00 .00 210.00 Grand Total 282.00 .00 .00 282.00 (# LQPERMIT 7j:�6 ; CITY• OF LA_ QUINTA SUB -CONTRACTOR LIST ` MOB ADDRESS �0'�fl5 �F �"� SAybn/)'f' PERMIT NUMBER OWNER `.BUILDER This form shall be posted on the job with theBuilding Inspection Card at all times in a conspicuous place. %-Only persons appearing on this. -list or�their employees: are authorized to_ work an this job. .Any, changes to this list must be approved.by the Building,Division prior to commencement of work.. Failure torComply ly will "re isult in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed byapp,licant.,. "On File"- is not an acceptable response. Trade /Class ificaUon ................... 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