05-1983 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
05-00001983
81685 BROWN DEER.PARK
767-540-005- -
WALL/FENCE
LOW DENSITY RESIDENTIAL
'3325
Architect or
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed urIgar provisions of Chapter 9 (commencing with
Section 7090) of pivision 3 of the Busjpacaepd Professionals my License is in full force and effect.
I hereby affirm under penalty of rtWry 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 ($5001.:
(_ 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 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 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sed.
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 I 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: n
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/24/05
Owner:
CALIFORNIA COVE Q L.Q. LLC
8105 IRVINE CENTER DRIVE
IRVINE, CA 92618
Contractor:
CALIFORNIA COVE COMMUNITIE INC -
8105 IRVINE CENTER DR STE 800
IRVINE, CA 92618
(949)453-1775
Lic. No.: 811053
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WORKER'S COMPENSATION DECLARATION
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.
_KI 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 STATE FUND Policy Number 1659679
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to beco j t to the ers' compensation laws of California,
and agree that, if I sho co lett rkers' compensation provisions of Section
�Ooi Labor ode th i comply tFjose provisions.
nt:
WARNING. FAILURE TO SECUR ORKERS' co ATION COV IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO C INAL PENALTIES AND CIVIL F ES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, 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 work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and cou y or finances and state laws relating to b ' e a Aeby authorize representatives
of this cou y to nter upon above-mentioned pr perty e
Dat ignature (Applicant or Agent):
Application Number . . . . . 05-00001983
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 63.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 3325
Expiration.Date . . 11/20/05
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
133 L.F. 6' GARDEN WALL, ORCO SYSTEM
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
I
LQPERMIT