04-4864 (BLCK)TAf 4 4 auba
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . .
04-00004864 Date
6/11/04
Property Address . . . . . .
55915 TURNBERRY WY
APN:
767-560-005- - -
Application description . . .
WALL/FENCE
Property Zoning . . . . . . .
LOW DENSITY RESIDENTIAL
Application valuation . . . .
2125
Owner
Contractor
FOUNTAIN STEVE
LAWRENCE, BUSTER L.
P.O. BOX 2939
9639 FOLARIS WAY
SARATOGA CA 95070
MORONGO VALLEY
CA 92256
(760) 272-5472
WCC: STATE FUND
WC: 17445692003
08/11/04
CSLB: 328825
06/30/06
CCC: B
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Permit . . . . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . . 54.00
Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
2125
Expiration Date . . 12/11/04
Qty Unit Charge Per
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG
----------------------------------------------------------------------------
2,001-25,000
9.00
Special Notes and Comments
85 L.F. 6' BLOCK WALL, CITY STANDARD
Fee summary Charged
Paid Credited
Due
Permit Fee Total 54.00
.00 .'00
54.00
Plan Check Total .00
.00 .00
.00
Grand Total 54.00
.00 .00
54.00
P.O. BOX 1504 _ •
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Cal
Date: C0- 11 _0
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code. and my Liceppr�� is in full force and effect
License Class i� - " License No 3 Z'g 2 S
�Oata_� — I � -b �Centractar,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031 5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or 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).):
U 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within 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.)
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law )
U I am exempt under Sec , BA P.C. for this reason
Owner.
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penally of perjury one of the following dectarations-
I have and will maintain a certificate of consent to self -insure for workers' tempensalion. as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' campensatio _insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which Ihis permit is
--issued My workers' compensation rance carrier and policy nu bar are:
lLalrier Policy Number 4
certifythat, m the performance of the work for which Ihis permit is issued. I sha11 not employ any person in any manner so as to became subject to the workers'
compensation taws of California, and agree that, if I should become subject 10 the workers' compensation provisions 0f Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
p oolicant
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION,, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Apptics tion is hereby made to the Director of 1uilding and Safety for a permit subject to the conditions and restrictions set forth an Ihis application 1. Each person upon whose behalf this application is made, each person at whose nder or rsuantto '
issued as a result of this application. the owner, and the applicaeach agrees to, and shall. defend, indemnify and hold haimmiassufhe Ci of La Quinfa nif pe�I
officers, agents and employees for any act a amrssion related 10 the work being performed under or foriawing issuance of this permd-
2- Any permit issued as a result of this application becomes null and void if work is not commenced within ta0 daytl from date of issuance of cessation 0f work for 1BO days will subject permit to cancellation. such pemdl or
i cartify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authanze representatives of this CO n the above-rtrentioned ry
p party for inspection purposes.
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