06-2841 (BLCK)4 4v Q
P.O. BOX 1504" VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 :. BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/28/06
Application Number: 06-00002841 __ Owner:
Property Address: 80525 VIA TALAVERATOLL CA V
APN: 772-250-999=144 -30357 - Y C/O KEVIN D DUERMIT
Application description: WALL/FENCE 8901 E MOUNTAIN VIEW 2 n 1
Property Zoning: LOW DENSITY RESIDENTIAL SCOTTSDALE,,- AZ 85258
Application valuation:. 2625
Contractor: AUG U 4 2006
Applicant:. Architect or Engineer: TOLL BROS INC.
14350 NORTH 87TH ST, S E 310IT:OFLAQUINTA
SCOTTSDALE, AZ 85260 Flp�pp�CEO
.(760)674-9699
Lic. No.. •777699
- 1
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with 1 -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 of the work for which this permit is
V issued. _
�te: v r ontractor. /�( 1/� 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 CLARATION 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' bor Code, I.shall forthwi c mply with those provisions. -
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by p �u ,y_n -
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: ate: v —r plicant: �-!l��ii''�, '
(_) .l, as owner of the property, or my employees with wages as their sole compensation, will do the work, and 00
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 OFTHELABOR 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 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,
(_I 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
- 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.
- 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 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 my to enter upon a above-mentioned property for ins ection Re—A—As.
Lender's Name:
Lender's Address: - . ate: 'nature (Applicant or Agent): • -
LQPERMIT -
LQPERMIT
Application Number . . . . . 06-00002841
Permit' WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 2625
Expiration Date 1/24/07
Qty Unit Charge Per
Extension
BASE.FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
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Special Notes and Comments
105 L.F. 6- GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited
Due
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Permit Fee Total 54.00 .00 .00
54.00
Plan Check Total .00 .00 .00
.00