04-5260 (BLCK)TAf 4 4Qr�xra
P.O. Box 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760) .777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number 04-00005260 Date 6/29/04
Property Address 77949 GREY WOLF TR
APN: 658-140-999-101 -29436 -
Application description . . . WALL/FENCE
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 1250
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 . . . . 31.00 Plan Check Fee .00
Issue Date Valuation 1250
Qty Unit Charge Per Extension
BASE FEE 15.00
8.00 2.0000 HND BLDG 501-2,000 16.00
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Special Notes and Comments
50 L.F. 6' GARDEN WALL, ORCO SYSTEM
Fee summary Charged Paid Credited Due
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Permit Fee Total 31.00 .00 .00 31.00
Plan Check Total .00 .00 .00 .00
Grand Total 31.00 .00 .00 31.00
JUL 0 3 '
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: � 10 6) 1 Date: ? - % - C '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 ofthe Business and Professionals
bode, and my License is full force and effect ��
License Class 'L<cense No-
Date r �Contractdr tr L `
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Ccntractors' State License Law for the following reason (Sec. 7031-5, Business and Professions Code: Any
city or county that requires a permit to conslruct. alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to Fite a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' Stale License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Coda) or that he ar she is exempt therefrom and the basis for the alleged exemption. Any violatian 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).):
( ) 1, as owner of the prop any. 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 Ihrough his or her awn employees, provided that the improvements are not Intended or offered for sale. If. however, the building or improvernent 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.).
( j 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 huIIds cr Improves Ihereon. and who contracts for the projects with a ccntractor(s) licensed pursuant to
the Contractors' State License Law.)-
U I am exampl under Sec, , B.& P.C. for this rcocon
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.
�i I have,&nd will plain rkers' compensation insurance, as required by Section 3700 of the L or Code, for the performance of the work for which this permit is
i o d M ers' mpensation insurance carrier and policy number are: G' (
emBr o cy Number 1 �
c 'fy l al, I the perfo ance of the work for which this permit is issued. I shall emp oy 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
to hwith comply with those provisions-
Date-7 ---ApplicantU IN J
i
WARNIN : F (LURE 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 J 1
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject fo the conditions and restrictions set forth on this application.
1. Each person upon whose he half 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 She City of La Ouinta, 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 vold if work is not commenced within 1St1 days from date of issuance of such permit, or
cessation of work for 180 days wilt subject permit to cancellation,
I certify that I have read this application and stale 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.
Date 7 Signature (Applicant or Agent):