05-3727 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
f LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
C05-00003727-
51180 AVENIDA CARRANZA
773-061-008- - -
WALL/FENCE
COVE RESIDENTIAL (�
8000 �I
Architect or
LICENSED CONTRACTOR'S DECLARATION
c&ty/ 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
AUG 2 3NO5
CITY OF L. _ayl TA
1 hereby affirm under penalty of perjury that I a ensed oder provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Bus' ass d Pr fessiona ode, and my Li nse is in full force and effect.
License Class: B Lice a No.: 862 1
Contractor.
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 (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 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 (5500).:
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 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 contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
f)�
Date: s Owner:
CONSTRUCTION LENDING AGENCY
I hereby,;iffirm 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:
LQPERMIT
Owner:
MEYER JAMES & SHERRY
51180 AVENIDA CARRANZA
LA QUINTA, CA 92253
Contractor:
BIRDSELL BUILDERS INC
P O BOX 630
LA QUINTA, CA 92247
(760)409-7070
Lic. No.: 862631
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/23/05
-----------------------------------------------
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. ..
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 EXEMPT Policy Number EXEMPT
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 o e subject to the workers. compensation laws of California,
and agree that, if I sho Id ecom s 'act to the workers' pensation provisions of Section
3700 of the Labor d shall rth 'h comply with those visions.
�Date:g Q�,%� Applicant: _ �.
WARNING: FAILURE TO SECURE WOR ERCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,0001. 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 Quima, 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 issu3e:
of such permit, or cessation of work for 180 days will subject
permit to cancellation. /-
I certify that I have read this application and stat th above information is correct. I agree to comply with all
city and county ordinances and stLe
r latbuildi construction, and hereby au orize representatives
of this county to enter upon the aionparty f 'inspection purposes.
C Date:� 7 L.ZSignture (Ar` v
LQPERMIT
Application Number . . . . . 05-00003727
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 99.00
Plan Check
Fee
.00
Issue Date . .
Valuation
8000
Expiration Date 2/19/06'
Qty Unit Charge Per
Extension
BASE FEE
45.00
6.00 9.0000 THOU BLDG 2,001-25,000
54.00
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Special.Notes and Comments
320 LF 6' GARDEN WALL-ORCO DETAIL
Fee summary Charged Paid
---------------------------
Credited
Due,'.
----------
Permit Fee Total 99.00
----------
.00
----------
.00
99.00
Plan Check Total .00
.00
.00
.00
Grand Total 99.00
.00
.00
99.00
M