07-1253 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00001253 j
Property Address: 46350 BRADSHAW-TR
APN: 643-170-999-49 -31348 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 4475
Ta�/ 4 42, a"
Applicant: Architect or Engineer:
0011-, air
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/24/07
Owner:
PH RANCH LLC
78370 HIGHWAY 111 STE 200
LA QUINTA, CA 92253
Contractor:
DESERT CONCEPTS LAND E
41800 WASHINGTON ST, 5
BERMUDA DUNES, CA 9 --0
(760)200-9007 APR 301001 I
Lic. Noo..:: 8 849837
c► "wlryTq NAM -
CE D
-------------------------------------------------------------------------------- IPJ ----
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C27 , C8 , C29 License No.: 849837 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
Date: Contractor:
OWNER -BUILDER DECLARATION
1 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 ($500).:
(_) 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 or she did not build or
improve for the purpose of sale.).
(► I, as owner of the property, am exclusively contracting' with licensed contractor to construct the project (Sec.
7044, Business and Professions Code: T tors' State License La does not apply to an owner of
property who builds or improves thereo , and who co acts for a of cts with a contractor(s) licensed
pursuant to the Contractors' State Lic se Law.).
(_) I am exempt under Sec. r1 B.&P C. for this reason
eat;: �� iZ wrier:
Of STRUCTION LENDINGO'NCI hereby affirm under penalty of perjury that th e i a construction lending athe performance of the
work for which this permit is issued (Sec. 309 C . C.).
Lender's Name:
Lender's Address:
LQPERMIT
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 REDWOOD FIRE & Policy Number W6734284
I certify that, in the performance of the ork fo hich this permit is ssu , I shall not employ any
person in any manner so as to bec a subject to a workers' c pe anon laws of California,
and agree that, if I ould m subject to the w ers' com ns io provisions of Section
3700 of the Lab Code, I shal rthwith comply wit hose p v' ion .
p` JO iA lica t:
WARNIE TO SECURE WORKERSC MPENSATION COVERA WFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEN IES AND CIVIL FINES U 0 HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO TH COST OF COMPENSATIO , D AGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S F .
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 an for
whose benefit work is performed under or pursuant to any permit issued as a result of th' application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold har ess the City
of La Quinta, its officers, agents and employees for any act or omission related to the ork being
performed under or following issuance of this permit.
2. Any permit issued as a result of this ap ' ation becom void if work is no ommenced
within 180 days from date of issua a of s h per , or cessatio f work f days will subject
permit to cancellation.
1 certify that I have read this application and s to that the a o information is correc ag e o comply with all
city and county ordinances and state laws rel ting to buildin nstruction, and hereby rize representatives
of this my to enterJepon tha above -menti ned property fo inspection purposes.
(Applicant or
6
1w1'
Application Number . . . . . 07-00001253
Permit . .
. WALL/FENCE
PERMIT
Additional desc
Permit Fee . . .
. 72.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 4475
Expiration Date
10/21/07-
0/21/07Qty
QtyUnit Charge
Per
Extension
BASE
FEE
45.00
3.00 9.0000
THOU BLDG
2,001-25,000
27.00
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Special Notes and
Comments
179 L.F. 6' GARDEN
WALL, CITY STANDARD
Fee summary
-----------------
Charged
----------
Paid
Credited
Due
Permit Fee Total
---------=
72.00
----------
.00
----------
.00
72.00
Plan Check Total
.00
.00
.00
.00
Grand Total
72.00
.00
.00
72.00
LQPERMIT