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04-6855 (BLCK)i u�i�,rcv BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number 04-00'006855 Date 10/20/04 Property Address . . . . . . 50777 SANTA ROSA PLAZA APN: 770-020-031-6-000000- Application description . . . WALL/FENCE Property Zoning . . . . . . . GOLF COURSE Application valuation . . . . 6112 Owner ------------------------ SANTA ROSA PLAZA 7902 S DEPEW STE 120 LITTLETON CO 80121 Contractor ------------------------ OWNER ---------------------------------------------------------------------------- Permit . . . . . . WALL/FENCE PERMIT Additional desc . . Permit Fee . . . . 90.00 Plan Check Fee .00 Issue Date . . . . Valuation 6112 Qty Unit Charge Per Extension BASE FEE 45.00 5.00 9.0000 THOU BLDG 2,001-25,000 45.00 ---------------------------------------------------------------------------- Special Notes and Comments 382 L.F. 314" RETAINING WALLS Q POOL AREA, PER APPROVED PRECISE Fee summary Charged Paid Credited Due Permit Fee Total 90.00 .00 .00 90.00 Plan Check Total .00 .00 .00 .00 Grand Total 90.00 .00 .00 90.00 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: >�� O .`� Date: Applicant: Architect or Engineer: Applicant's Mailing Address: 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 License is in full force and effect. License Class License N❑ Date 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 Profess€ons Code: Any city or county that requires a permit to construct, alter, improve, demoi[sh, or repair any structure, prior to Its issuance, also requires the appiicant 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 civ[I penalty of not more than rive hundred dollars ($500).): (J 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 bulid s 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 an year of completion, the owner -builder will have the burden of proving that he or she dId not build cr improve for the purpose of sale.). 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 ccntractcr(s) licensed pursuant to the Contractors' State License Law , U I am exempt under Sec. B.& foLLhh reason 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 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 issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number I certify that, in the performance 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 C ' , and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall AFINES fort with comply with ose pro s' f uaSp n! WAAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVUP 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 Building and Safety for a permit subject to the conditions and restrictions set forth an this application. I Each person upon whose behalf this appl[catiorr 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 hammless the City of La Quints, its Officers, agents and employees far 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 18o days from date of issuance of such permit, or cessation of work for 180 days will subject permit to ncellation_ I certify that I have read this application and state that the a e In rma act. I agree to com ly with all city and county ordinances and state laws relating to building construction, and h eby authorize representatives of thi aunty to er on above-m nfloned Dperty for inspection purposes. at ignalure (Applicant or sot): r5 �J I) i �n 0 All .. g718bSSY ffiIIi'P88 gQrELBe) Sxnra Rosa Plaza P o Box 1503 50-920 A renids Bermudas xu guirrra, CA 92233 Dennis Atwood, constructionManaSer Construction office Phone 760 771aS343 Faa 760 771 6361 Dennis Cell 760 200-7577 email: y1 nnatwoodl@etizon.net