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05-1861 (BLCK)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: 5/16/05 Application Number. 05 0.000ltt,6l, Owner: Property Address: 5 -os- o vrsTA'MONTANA LEVINE-MUNDT APN: 772-260-012- - 50350 VISTA MONTANA Application description: WALL/FENCE LA QUINTA, CA 92253 Property Zoning: VERY LOW DENSITY RES Application valuation: 2720 Contractor: Applicant: Architect or Engi 1 COURTMASTER SPORTS INC �QWN�p, P O BOX 580795 /Q N PALM SPRINGS,'CA 92258 (760)25i-5201 A F�NA�CE / !!!! LiC. No.: 748731 LICENSED CONT CTOR'S DECLARATION' WORKER'S COMPENSATION DECLARATION hereby'affirm under penalty of erju that I am license er provisions of Chap t 9 (commencing with 4 1 hereby affirm under penalty of perjury one of the following declarations: - . Section 7000) Division 3 of t Bu the" and Profes o s Code, and my Lic a is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided _ License ss: Cl C61 LicenseNo.: 7 31 - for by Section 3700 of the Labor Code, for the performance of the work for which this permitis issued. Date' / ontracto - _ _ 1 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: - I hereby affirm under penal o erjury.that I am exempt from the Contractor's State License Law for the - Carrier STATE FUND Policy Number 1795435 following reason (Sec. 70 1 ,Business and Professions Code: Any city or county that requires a permit to_ I certify that, in th perfo ance of the work for which this permit is issued, 1 shall not employ any _ construct,,alter, improve, molish, or repair any structure, prior to its issuance, also requires the applicant for the person in any anner as to become subjec a 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 sho Id become subject t he orkers' compensation isions of Section •-License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or _ 37 0 ofd-.'.'." �r Coe hall forthwit o with those: provisi 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 d:r�te: plizant (_ 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 WAR ING: AILURE TO C WORKE COMENSATION COVERAGE IS UNLAWFUL, AND SHALL , Contractors' State License Law does not apply to'an owner of property who builds or improves thereon, .SUBJECT AN EMPLOYE TO RIMINAL 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): 1 DDITION 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 T ABOR 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 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, 1 —1 I am exempt under Sec. , B.&P.C. fovthis 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 issuan ch 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 l: have read this application and state hat th above information is rrecY. I agree to comply with all work for which this permit is issued (sec. 3097, Civ. C.). city and coun ordinances and state laws relating bui ing c nstruction, ereby authorize repr tatives, _ - - of this co o enter upon the above-mentioned p s tion oses. Lender's Name: _ at ignature (Applicant or Ag - Lender's Address: ' LQPERMIT - Application Number . . . 05-00001861 Permit WALL/FENCE PERMIT' Additional desc .. ' Permit Fee'.. 54.0.0 Plan Check Fee.. .00 Issue Date . . Valuation . . 2720 Expiration Date 11/12/05 . Qty Unit Charge Per Extension" BASE FEE 45.00 . 1.00' 9.00.00 THOU BLDG 2,001-25,000 9.00 ---------------------7 -------------------------------------------- Special Notes and Comments 320 L.F. 8' VINYL COATED CHAIN:LINK FENCE AROUND -TENNIS COURT PER APPROVED. PLAN Fee summary Charged Paid Credited.. Due --------------- Permit Fee Total 54.00.AO ---------- .00 54.010 Plan Check Total. .00 .00 .00 .0.0 Grand�Total 54.00 .00-. .00 54.00 } LQPERMIT ..