04-5253 (BLCK)Titf 4 4Q"
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 . . . . . 04-00005253 Date 6/29/04
Property Address . . . . . . 77858 GREY WOLF TR
APN: 658-140-999-94 -29436 -
Application description . . . WALL/FENCE
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 1000
Owner
IVANHOE LA QUINTA COVE
C/O R BARRY MCCOMIC
7979 IVANHOE AVE STE 550
LA JOLLA CA 92037
Contractor
TRANS WEST HOUSING, INC.
9968 HIBERT STREET, STE #102
SAN DIEGO
CA 92131
(858)
653-3003
WCC:
STATE FUND
WC:
1648813
10/01/04
CSLB:
701039
01/31/05
CCC:
B
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Permit . . . . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee 25.00 Plan Check Fee .00
Issue Date Valuation . . . . 1000
Qty Unit Charge Per
Extension
BASE FEE 15.00
5.00 2.0000 HND BLDG 501-2,000 10.00
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Special Notes and Comments
40 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
Permit Fee Total 25.00 .'00 :00 25.00
Plan Check Total .00 .00 .00 .00
Grand Total 25.00 .00 .00 25.00
L:
JUL J u�I1
_r'T
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: 0 5.� 5-3 I Date: 7 - -7 - O
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
N
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 License n full force and effect. �i ]
License Class •'License No. �r
Date ontractor Lti U L
OWNER -BUILDER DECLA ON
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 Cade) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 703 1, 5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than rive hundred dollars ($500)J-.
(} [, as owner cf 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 Prafessions 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 awn 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 She purpose of safe.).
( ) 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 I an owner of property who builds a improves thereon, and who can tracts for the projects with a cantractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , B.& P.G- for Ihis reason
Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, 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 m ontain workers' compensation insurance, as required by Section 3700 of the abcr Code, for the performance of the work for which this permit is
u d. My, ers';mpensation ink ce carrier and policy number are: f
-Carrier of Cy Number j
I certily that, in the perfo ante of the work for which this permit is issued, I shall n employ any pe an in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
,`Date 1 11104 - Ai:n .
VVARNIN FMLURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FIN S 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 Appk:abon is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth an this appllcation-
1. Each person upon whose behalf Ihis application is made, each person at whose request and for whose benefit work is performed under a pursuant to any permit
issued as a result of this application, this owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quin La, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
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 permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all c}ty and county ordinances and state laws relafing to building
constructia , an hereby authorze representatives of this county to enter on th�e�faboentioned property for Inspection purposes.
date l Signature (Applicant or Agent); ['���