07-1269 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: r 07-00001269
Property Address: L 46734 BRADSHAW TR
APN: 643-170-999-65 -31348 -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3350
c&ht 4 4 Q"
Applicant: Architect or Engineer:
eve'
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LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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,C8,C29 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 ISec. 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 applicantJor a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ 1 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 ' roves thereon,
and who does the work himself or herself through his or her own employees, prov' d that the
improvements are not intended or offered for sale. If, however, the building or ' provement is sold within
one year of completion, the owner -builder will have the burden of proving t t he or she did not build or
improve for the purpose of sale.).
1 1 1, as owner of the property, am exclusive) ting with license ntr tors to construct the project (Sec.
7044, Business and Professions Cod The Con tors' State L e s Law does not apply to an owner of
property who builds or improves th eon, and who c racts for he rojects with a contractor(s) licensed
pursuant to the Contractors' State icense Law.l.
I—) I am exempt under Sec. B P.C. for this reason
Date:i Owner:
1/CONSTRUCTION LENDING1AGYNCY
I hereby affirm under penalty of perjury that {here is a construction lending boncy for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
PH RANCH LLC
78370 HIGHWAY 111 STE 200
LA QUINTA, CA 92253
D
Contractor:
DESERT CONCEPTS LAND CP /
41800 WASHINGTON ST, B-10
BERMUDA DUNES, CA 92101--
(760)200-9007
Lic. No.: 849837
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/24/07
IX u
APR 3 0 2007
kINT
ITY OF LA QUINTA
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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 Se on 3700 of the Labor
Code, for the performance of the work for which this per it is issued. y workers' compensation
insurance carrier and policy number are: '/T�\
Carrier RZDWOOD FIRE & olic ber W67h4a84
certify that, in the performs a of the work fN.de
er it is ' sued, I shall not employ any
person in any manner so to become subjer ' c pensation laws of California,
and agree t I shoul become subject tco nsation provisions of Section
3700 of t eLabo Cod I shall forthwith cse rovisions.
WARNING: FAILURE TO SECURE W KERS' COMPENSATION COVERAQE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CIVIL FINES UPTO ONE HUNDRED THOUSAND
DOLLARS IS 100,000). IN ADDITIO TP THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR COD INTEREST, AND ATTORNEY'$ 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 thi application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold her 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 application becom II and void if wo i no commenced
within 180 days from date of issuance of such per it, or ce ion of wo for 1 0 days will subject
permit to cancellation.
I certify that I have read this application and ate that a ab ve information is co . I ag a to comply with all
city and county ordinances and state laws r ating to bw in construction, and here t ize representatives
of this c inty to enter upon the above -me ioned propert r inspection purposes.
Dat Si ure (Applicant r Agent):
Application Number . . . . . 07-00001269
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 63.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 3350
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
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Special Notes and Comments
110 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
LQPERMIT