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05-4663 (BLCK)P.O.. BOX 1504 _ . ^� VOICE (760) 777-7012 78-45 CALLE TAMPICO 44- FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/17/05 Application Number: 05-00004663 Owner: Property Address: 5162-9—VIA—SORRENTO TOLL CA V APN: 772-250-997-79 -31349 OC/.O KEVIN D DUERMIT Application description: WALL/FENCE -8901 E MOUNTAIN VIEW 200 Property Zoning: LOW DENSITY RESIDENTIAL Q SCOTTSDALE, AZ 85258 Application valuation:' 1875 0 Contractor: Applicant: Architect or.Engineer: w�j. j OLL BROS,. INC. 4U� 73121 FRED WARING DRIVE, #100 PALM DESERT, CA 92260 (760) 674-9699 Lic. No.: 771699 • 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.perjuryone of the following declarations: Section 7000) of Division 3 of the Business.and Professionals Code, and my License is in full force and effect. Ihave 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 of the work for which. this permit is issued. Date: ontractor: ���/" r�S —111 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 ZURICH INS -Policy Number WC387821300 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 tothe 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 Labor -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 �D / - _ any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: - e:� �2 �� pplicant: ( _ r455 _ I_ 1 1, 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 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 . 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 o�vner.of conditions and restrictions set forth on this application. ' property who builds or improves thereon, and who contracts for the projects with a contractot(sl-licensed - 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' StateLicenseLaw.).- - "'y?�., - whose benefit work is performed under or pursuant to any permit issued as a result of this application, - (_ 1 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. 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. - - hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the 1 certify that.1 have read. this application 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.) _ - city and county ordinances and state laws relating to building construction, and hereby authorize representatives " of this county to enter upon the bove-mentioned property f r inspection purposes. - Lender's Name: � ature (Applicant or Agent): Lender's Address: LQPERMIT Application Number 05-00004663 Permit• . . WALL/FENCE PERMIT Additional desc . Permit Fee 43.00 Plan Check Fee .00 Issue Date . . . Valuation 1875 Expiration Date.. 4/15/06 Qty Unit Charge, Per Extension BASE FEE 15.00 . 14.00 2.0000 HND BLDG 501-2,000 28.00 ---------------- - --- Special Notes and Comments -------------- --- - 75 L.F. 6'8" GARDEN WALL, ORCO SYSTEM" Fee summary Charged Paid Credited Due Permit Fee Total 43.00 .00 .00 43.00 Plan Check Total .00 _00, .00 .00 Grand Total 43:00 ..00 .00 43.00 LQPERMIT ....