08-1822 (BLCK)on
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4&t °f 4 Q"
Application Number: C-08-00001822
Property Address: 52395 VIA SAVONA
APN: 772-480-027- - -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3681
Applicant : > Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury that I 'censed provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busine and ofes ' n Code, and my License is in full force and effect.
License Cie : B License No.: 3856
`Date: -I uQCpntractor:",
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of ' ry that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
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).:
(_) 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 ISec. 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 does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
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.).
(_) I, 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 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 ISec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPERMIT
Owner:
SANTA LUZ ESTATES INC.
8168SANTALUZ VILLAGE GREEN N.
SAN DIEGO, CA 92127
Contractor:
SOMERS CONSTRUCTION INC, RICK
326 ENCINITAS BLVD, STE 100
ENCINITAS, CA 92024
(760)633-1324
Lic. No.: 483856
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/04/08
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a
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WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate of consent to self -insure for workers' compen tion,,as,provided
for by Section 3700 of the Labor Code, for the performance of the work for whic this permit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 f the Labor
Code, for the performance of the work for which this permit is issued. My workers' c mpensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 044-0025683
I certify that, in the performance o the work for which this permit is issued, I shall not employ any
person in any manner so a b comes bject a workers' compensation laws of California,
and agree that, if I shout eco e I t t e orkers' compensation provisions of Section
37 of the Labor Co , I s I rt i o y with tho pro isions.
Date: / pplicant:
WARNING: FAILURE TO S U ORKERS' C MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 followingissuance 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 a e in rmation is correct. I agree to comply with all
city and county ordinances and state laws relating to buil ng co ruc ion uthorize represe�ptatives
of this count to a ter upon the above-mentioned pro ty for ' p e
Date: Q ignature (Applicant or. Agent
Application Number . . . . . 08-00001822
PermitWALL/FENCE PERMIT
Additional dean
Permit Fee . . . . 63.00
-Plan Check
Fee
.00
Issue Date
Valuation
. . .
.
3681
Expiration Date . . 5/03/09
Oty Unit Charge Per
Extension
EASE
FEE
95.00
2.00 9.0000 THOU BLDG
3,001-25,000
18.00
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Special Notes and Comments'
170 IN FT X 5 FT HT GARDEN BLOCK
WALLS
PER CITY STANDARDS 6 APPROVED PLANS
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
em a
City Of La Quints
Building s Safety Division
P.O. Bon 1504, 78.495 Cage Tampico
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit N
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A. P. Number: t 3LZ - 4ZQ-02 -I
Address: 916Y NL u
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APPLICANT: DO NOT WRTE BELOW THIS LINE
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