04-5246 (BLCK)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 04-00005246 Date 6/29/04
Property Address 77900 GREY WOLF TR
APN: 658-140-999-91 -29436 -
Application description . . . WALL/FENCE
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 3500
Owner
IVANHOE LA QUINTA COVE
C/0 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 . . . . 63.00 Plan Check Fee .00
Issue Date . . . . Valuation 3500
Qty Unit Charge Per Extension
BASE FEE 45.00
2.00 9.0000 THOU BLDG 2,001-25,000 18.00
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Special Notes and Comments
140 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
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Permit Fee Total 63.00 .00 .00 63.00
Plan Check Total .00 .00 .00 .00
Grand Total 63.00 .00 .00 63.00
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P.O. BOX 1504 ■ VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: ' e-1
Applicant:
Applicant's Mailing Address:
0 9-sa
Date: ' % - d Y
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under PPgg;yIty 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 Licensepin full force and effect. p, r
License Cl ss� e e [� G
OWNER�BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor' 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 Cantractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he a she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 70 31 -5 by any applicant fora permit subjects
the applicant to a civil penalty of not more than rive hundred dollars (5500).):
L) I, as owner of the property, or my employees with wages as their safe compensation, will do the work, and the structure is nat intended or offered for sale (Sec. 7044,
Business and Professions Cod e• The Cantractors' 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 Dwner-builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U t, as owner of the property, am exclusively contracting with licensed contractors to construct the Praia of (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 contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
Li I am exempt under Sec , 3.& R.C. for this reason
Owner
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.
Al have and will maintain workers' compensation insurance, as required by Section 3700 of th bor Code, for the performance of the work for which this permit is
ue y w e romp nsatio7_iasffrence carrier and policy number are: r_ j'
arrier �_ ��''1ILL \\ 'Policy Number & I {
I certify that, in th perfan nonce of the work for which this permit is issued, I shall not employ any person 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
f hwith comply with those provisions.
�
Date I
Applicant L V :1
WARNIN : F1;P
ILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES 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.).
Lenders Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditlans and restrictions set forth on this application.
1. Each person upon whose behalf this application is mada, each person al 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 Cityof La 4uinta. 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 IN application becomes null and void if work is not commanced within 180 days from dais 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, and hereby authorize representatives of this county to enter upon the above -mentioned property for inspection purposes.
D3Ee Signature (Applicant or Agent):