07-1248 (BLCK)-yY'T
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
.07-00001248
Property Address:
54036 RIVIERA
APN:
775 -030 -019 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
2750
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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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. _
Lice s Class: B. ^LicensetNo.: 86101
at • C9 ractor:
. OWNER -BUILDER DECLARATION
. I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason ISec. 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 issuarice, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's 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 civil penalty of not more than five hundred dollars ($500).:
(_ 1 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 builds or improves thereon,
.and who does the work himself or herself 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.).
1, 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 contractor(s) licensed
pursuant to the Contractors' State License Law.). .
1 1 I am exempt under Sec. , B.&P.C. for this reason '
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is aconstruction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.I.
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
RIVIERA VILLAS
1651 E 4TH ST NO 228
SANTA ANA,. CA .92701
Contractor:
FIRST PACIFICA HOUSING
300 EAST,STATE.STREET,
REDLANDS, CA 92373
(909)798-3688
Lic. No.: 861014
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/10/07
WORKER'S 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.
V_ 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 REDWOOD FIRE Policy Number W6634267
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 California,
and agree that, . should become subject to the workers' compensation provisions of Section
Dat%
(� 3700 oft abor Code, I shall forthwi h com with h se provisiAons.
Applicant: '
WARNING: FAILURE 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.
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 on this application.
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 Quinta, 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
pellnit to cancellation.
ZDa• I have read thislapplication and state that the above information is correct. I agree to comply with all
nty ordinanc s and state laws relating to building construction, and hereby authorize representatives
y to enter Pon the above-mentioned pppee`rty for inspection purpo s.
ignature (Applicant or Agen1ST� VX
Application Number . . . . . 07-00001248
Permit . . ." WALL/FENCE
PERMIT
Additional desc
Permit Fee 54.00
Plan Check
Fee
.00
Issue Date
Valuation
2750
Expiration Date 11/06/07
Qty Unit Charge Per
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG•2,001-25,000
9.00
--------------------------- -------------------------------------------------
Special Notes and Comments
110 L.F. 6' GARDEN WALL,, CITY STANDARD
Fee summary Charged
Paid Credited
Due
Permit Fee Total 54.00
.00
.00
54.00
Plan Check Total .00
.00
.00
.00
Grand Total 54.00
.00
.00
54.00
LQPERMIT