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06-2382 (BLCK)P.O.'BOX 1504 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT — Da 6/14/06 Application Number: 06-00002382 Owner: a Property Address: 80850 VISTA LAZO FRANK GRESIK p ,:•�', APN: 762-250-024- - - 80850 VISTA LAZO D Application description: WALL/FENCE LA QUINTA, CA 92253 2006 Property Zoning: LOW DENSITY RESIDENTIAL A Application valuation:, 15000 pf 6,A QWIPITA Contractor: Applicant: - Architect or Engineer:. LANGFORD CONSTRUCTION F 57845 SOUTH VALLEY LN LA QUINTA, CA 92253 (760)771-6299 Lic. No.: 401700'. ------ • LICENSED CONTRACTOR'S DECLARATION _ WORKER'S COMPENSATION DECLARATION .. hereby affirm urider 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-C8 License No.:- 401700 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Date: Contractor: _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor - Code, for the performance of the work forwhich this permit is issued. My workers' compensation. OWNER-BUILDER DECLARATION insurance carrier and policy number are: - - 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ATE FARM Policy Number 90XP95596 - - - • following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to - j ' 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 subj ct 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 �l shall f rth 'th comply ith those p' isions. - that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by r/ . any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001.: �Date:�Applica t:`_ 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: 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 (j 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 result of this application, - 1 _) I am exempt under Sec. B.&P.C. for this rearson 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 1�,2 O( performed under or following issuance of this permit. Date: (a J 1p �• .own. .XAA�� 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 constructio and hereby uthorize representatives of this cp//u nt to enter upon the above-mention top or inspe tion urpposes. �-- Lender's Name: -- -- _ Date: �C4 Signa ture_(Applicant or A Lender's Address: LQPERMIT - , -Application Number . . . 06-00002382 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee' .162.00 Plan Check Fee .. .00 Issue Date Valuation 15000 Expiration Date 12/11/06 Qty Unit Charge Per Extension BASE FEE 45.00 THOU BLDG 2,001-25,000 �l -------13_00_-------9_0000 -----------------------------------=--- - --117_00- Special Notes and Comments 600 LF 6' BLOCK WALL PER PLAN/CITY STANDARD. NOTE: ENTRY TRELLIS @ 2 X 4 COLUMNS DOES NOT REQUIRE PERMIT: Fee summary Charged, Paid Credited Due Permit Fee Total 162.00 .00 .00 162.00 Plan Check Total .00 .00 .00 .00 Grand Total 162.00 .00 .00 162.00 LQPERMIT -