10-0985 (BLCK)P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: �10 00000985--_1
Property Address: 46470 BRADSHAW =TR
APN: 643-170-99 -54' -31348
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1234
Ta�14'4Q*&
Applicant: Architect or Engineer:
C6 ENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirm under penalty of perjury at 1 m license unde provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busi es and Professi als C de, and my License is in full force and effect.
License Class: B se No.: 4 4 6 8
D3te:r� ntractor: I
Il OWN R -BUILDER CLARATIO
I hereby affirm under penalty of perjury that I am exempt from the ontractor's St a License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: A y city or count that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to issuance, o requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to t isions 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 he or she did not build or
improve for the purpose of sale.).
(_ 1 -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 1 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 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:
GLOBAL INVESTMENTS
3470 WILSHIRE BLVD. 41020
LOS ANGELES, CA 90010
N
Contractor:
FD CONSTRUCTION
73081 FRED WARING DRI
PALM DESERT, CA 92260
(760)776-8300
Lic. No.: 814468
VOICE (760) 777-7012
FAX (7610) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/23/10
j,
01i 0C 204 I
City OF LA QUIN'
F[MANCE 7EP7
-------------------
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
iss
1 haveve 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 GRANITE STATE—Pelicv Number WC003957781
I certify that, in the partanc
which this permit is issued, I shall not employ any
person it any mannerbject o the workers' compensation laws of California,
and agree that, if I s workers' compensation provisions of Section
X700 grt{ie Labor comfit '7�<
isr ns.
ic
a_s
J,e
RNING: FAILU ER TO SECURE WORKERS' COMPENSATION OVERAGE IS NLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL INES UP TO 0 HUNDRED THOUSAND
DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMP SATION, DAM GES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORN '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 be es null and void if work is not commenced
within 180 days from date of issuance oftion of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state :Zjr&
tion' correct. I agree to comply with all
city and county ordinances and state laws relati tod hereby authorize representatives
off IN county, Jefe to pri the above-mentione prp es.
Dale:\/T\� � Si lure (Applicant or Agent):
L 07
Application Number
Permit .
Additional desc
Permit Fee
Issue Date
Expiration Date
'10-00000985
WALL/FENCE PERMIT
31.00 Plan Check Fee
.Valuation
3/22/11
.00
1234
Qty Unit Charge Per
Extension
BASE
FEE
15.00
8.00 2.0000 HND BLDG
--------------------------------------------------------------------7-------
501-2,000
16.00
Special Notes and Comments
TOTAL OF 57 L.F. 5' GARDEN WALL
TO
CREATE COURTYARD, CITY STANDARD.
2007
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG
STDS ADMIN (SB1473)
1.00
Fee summary Charged
-------------------------------------
Paid
Credited
--------------------
Due
Permit Fee Total 31.00
.00
.00
31.00
Plan Check Total .00
.00
.00
.00
Other Fee Total 1.00
.00
.00
1.00
Grand Total 32.00
.00
.00
32.00
LQPERMIT
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