04-5254 (BLCK)Titf °F4a
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 . . . . . 04-00005254 Date 6/29/04
Property Address . . . . . . 77865 GREY WOLF TR
APN: 658-140-999-95 -29436 -
Application description . . . WALL/FENCE
Property Zoning . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 1500
Owner
IVANHOE LA QUINTA COVE
C/O R BARRY MCCOMIC
7979 IVANHOE AVE STE 550
LA JOLLA CA 92037
Contractor
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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 01/31/0E
CCC: B
Permit . . . . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 35.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 1500
Qty Unit Charge Per Extension
BASE FEE 15.00
10.00 2.0000 HND BLDG 501-2,000 20.00
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Special Notes and.Comments
60 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
Permit Fee Total 35.00 .00 .00 35.00
Plan Check Total .00 .00 .00 .00
Grand Total 35.00 .00 .00 35.00
7,;0�"-Ilar�
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: v ,J� - 5 4, 1 Date: 1 - r `f
Applicant:
Applicant's Mailing Address:
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
erode, and my Ucen s in full force and effect /1 f Q
r" License Class License No.
Date � � -actor /t��y�'�� �ti}�r'� cc t ( �'�•
OWNER -BUILDER DE RATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' Stale 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 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, witl do the work, and the structure Is not intended or offered for sale (Sec- 7044,
Business and Professions Cade- 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-).
( ) I, as owner of the property, am excl usively'cont racting with licensed contractors to construct the project (Sec. 7D44, 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 contractors) licensed pursuant to
the Contractors' Stale License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury 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.
1f� 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
i sued. My workers' compensation insurance carrier and policy number are:
Carrier � - policy Number
rcerlify that, in the performance of the work for which this permit is issued, i shall net employ any parson in any manner so as to become subject to the workers'
compensation laws of Califomia, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
f dhwith comply with those previsions. II
�Ctate pplirant r V
WARNINV ; FA LURE 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 Application is hereby made to the Director of Buitding and Safety for a permit subject to the conditions and restrictions set forth on this applicadon
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1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Ouinta, its
of rers, agents and employees for any act cr omission related I the work being performed under or following issuance of this permit.
P. Any permit issued as a resuit of this application becomes null and void if work is not commenced within 160 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 city and county ordinances and state laws relating to building
construction, nd ereby authorize representatives of this county to enter upon the above- mentioned property for inspection purposes.
Date C ignature (Applicant or Agent): M/-,7�r