05-4661 (BLCK)•
P.O. BOX 1504 ^�
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
r BUILDING PERMIT.
Application Number:
05-001004661
Property Address:
5160*5—VIA SORRENTO
APN:
772-250-997-80 -31349 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1050
Applicant: Architect or Engineer:
Owner:
O TOLL CA V
C/O. KEVIN D QUERMIT
8901 E MOUNTAIN VIEW 200'
:® SCOTTSDALE, AZ 85258
ars, •
C, \� ontractor:
A, O 1 T- L BROS, INC.
�'S��(� 1 FRED WARING DRIVE, #100
M DESERT, CA 92260
(760)i574-9699
Li.C. No.: 777699
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/17/05
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V
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- - LICENSED 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: B • License No.: 777699
_
for by Section 3700 of the Labor Code, for the performance ofthe work for which this permit is "
ate: ractor. �� • �/V %� S -
issued.
$1 have and will maintain workers' compensation insurance, as required 6y 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 ZURICH INS Policy Number WC387821300
..following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permifto
_ 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 pursuanfto 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 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the L or Code, I shall forthwith comply 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).:
ate: plicant: -'
and
(_) I, as owner of the property, or my employees with wages as their sole compensation, will d0 the work, and
-
the is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: 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 arenotintended 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
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
i. .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 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. -'An y permit issued as a result of this application becomes null and void if work is noTcommenced
. - -
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
Icertify that I have read this application and statethat the above information is correct..) agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to building construction, and here y authorize representatives
- '
of this county to enter upon the above-mentioned property for inspectionpu( oses. -
Lender's Name:
- - ^
eature (Applicant or Agent):Lender's
Address:
-
LQPERMIT
Application Number 05-00004661
Permit . . .. WALL/FENCE
PERMIT
Additional desc .
Permit. Fee 27.00
Plan Check
Fee
.00 .
Issue Date
Valuation
.
. 1050'
Expiration Date
Qty Unit Charge Per,
Extension
BASE
FEE
15.00
6.00 2.0000 HIND BLDG
50.1-2,000
12.00
Special"Notes and Comments
- ----------------------
42 L.F. 6'81" GARDEN WALL, ORCO SYSTEM
Fee summary, Charged
Paid Credited
Due
Permit •Fee Total 27.00"
.00
.00
27.00
Plan Check Total .00
.00
.00
.00
Grand Total 27.00.
.00
.00
27.00
Y
LQPERMIT _
..