07-1254 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: ('07-00001254i
Property Address: 46374 BRADSHAW TR
APN: 643-170-999-50 -31348 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3000
T -414t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
PH RANCH LLC
78370 HIGHWAY 111 STE 200
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer: DESERT CONCEPTS LANDSCPE/MA
41800 WASHINGTON ST, B-105
BERMUDA DUNES, CA 92201--0
(760)200-9007
Lic. No.: 849837
I
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that Iam 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: (227,C8,1229 License No. : 849837
Date: 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 ($500).:
(_ I 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 the did not build or
improve for the purpose of sale.).
( 1 I, as owner of the property, am exclusively contracting with licensed contract to construct the project (Sec.
7044, Business and Professions Code: The actors' State License w does not apply to an owner of
property who builds or improves thereon, nd who tracts for the ojects with a contractor(s) licensed
pursuant to the Contractors' State Lice n Law.).
1 _ 1 I am exempt under Sec. P. . for this reason
Date: wer'
I hereby affirm under penalty of perjury that there is a construction lend ency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:'
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/24/07
A r
Q
OF LA
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 REDWOOD FIRE & Policy Number rV6734284
1 certify that, in the perfor nce the work for hick this p mit is issued, I shall not employ any
person in any manner o as to be a subject th w kers' compensation laws of California,
and agree th if I s uld becomes 'ect to th wor rs' compensation provisions of Section
3700 of the Lab de, I shall forthwi comp those provisions.
WARNING: FAILURE TO SECURE ORKERS' COM
PENSATI VERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIt�IAL PENALTIES AND CIWINES UP -TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDIT TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR C DE, 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 wok is not commenced
within 180 days from date of is ce of sFabove
or cessation of wo for 180 days will subject
permit to cancellation.
I certify that I have read this application a d state th thnform is co c . I agree to comply with all
city and county ordinances and state law relatingto itructio d here authorize representatives
of this_p ty6ty to enter upon thg,above- entioned proppection urp s.
or Agent):
F
LQPERMIT
Application Number . . . . . 07-00001254
Permit . .
. WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . .
. 54.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 3000
Expiration Date .
. 10/21/07
Qty . Unit Charge
Per
Extension
BASE
FEE.
45.00
1.00 9.0000
THOU BLDG
2,001-25,000
9.00
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Special Notes and
Comments
120 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