07-1255 (BLCK)P.O. BOX 1504 �^� VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153.
BUILDING PERMIT
Dater 4/24/07
Application Number: C07-00001255 ( Owner:
Property Address: 46398 BRADSHAW TR PH RANCH LLC
APN: 643-170-999-51 -31348 78370 HIGHWAY 111 STE 20
Application description: WALL/FENCE LA QUINTA, CA 92253 D d
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3375 APR Contractor: Hr' • 3 0 2097
Applicant: Architect or Engineer: DESERT CONCEPTS LANDS E
41800 WASHINGTON ST, -105 FNAD) C q��NTq
BERMUDA DUNES, CA 92201-- EDEpT
(760)200-9007
1 A Lic. No.: 849837
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: C27,128,1229 LicenseNo.: 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 th(he'she did not build or
improve for the purpose of sale.).
( I, as owner of the property, am exclusively contracting with licensed contra rstruct the project (Sec.
7044, Business and Professions Code: The Contractors' State License at apply to an owner of
property who builds or improves thereon,an tracts for the pro a contractor(s) licensed
pursuant to the Contractors' State License w.l.
(_ 1 I am exempt under Sec.. .&P.C. f this reason
ate:0 O ner:
COffTRUCTION LENDING AGEN�
I hereby affirm under penalty of perjury that there i a construction lending agency the performance of the
work for which this permit is issued (Sec. 3097, C C.).
Lender's Name:
Lender's Address:
LQPERMIT
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.
1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for whic5witho
is issued. M workers' compensation
insurance carrier and policy number are:
Carrier REDWOOD FIRE & Policy Number
I certify that, in the perforrshall
ork for wit is issued, I shall not employ any
person in any manner some ject ts' compensation laws.of California,
and agree that, if I shosubject thmpensation provisions of Section
3700 of the Labor Cod rthwith co provisions.
WARNING: FAILURE TO SECURE W ERS' COMPENSATION'C V AGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI+PENALTIES AND CIVIL FI UP TO ONE HUNDRED THOUSAND
DOLLARS 15100,0001. IN ADDITIO T THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR COD NTEREST, 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 resultIof this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and ho harmless the City
of La Quinta, its officers, agents and employees for any act or omission related the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and voi if or is not commenced
within 180 days from date of issuance of such permit or cessation f w for 180 days will subject
permit to cancellation.
I certify that I have read this applicationfasat'�'te that a ab a informati is c rrec I agree to comply with all
city and county ordinances and state lagtobw in construction, an rebthorize representatives
of this goynty to enter upon the above -d prop
f r inspection purpos
or Agent):
LQPERDIIT
Application Number
.. . . . . 07-00001255
Permit . .
. WALL/FENCE PERMIT
Additional desc .
Permit Fee . . .
. 63.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 3375
Expiration Date
10/21/07
Qty Unit Charge
Per
Extension
BASE FEE
45.00
2.00 9.0000
THOU BLDG 2,001-25,000
18.00
----=------------------
Special Notes and
-----------------------------------------------------
Comments
''/� L.F. 6- GARDEN
WALL, CITY STANDARD
Fee summary
-----------------
Charged Paid
Credited
=---------
Due
Permit Fee Total
--------------------
63.00
.00
----------
.00
63.00
Plan Check Total
.00
.00
.00
.00
Grand Total
63.00
.00
.00
63.00