05-2620 (BLCK)• �t
1 O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
W.;t -0
Application Number: i .05.:00002620 i
Property Address: 81705 BROWN DEER PARK
APN: 767-540-007- -
Application description: WALL/FENCE
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 250
Tay/ 4 4 Q"
Architect or Engineer
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
--------------------------------------------------
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 Professi als Code, and 'cense is in full force and effect.
License CI s: B, Licen 053
at o ontractor. -
OWN -BUILDER OECLA�F;AFf N
I hereby affirm under penalty of perj� y tat I am exempt ontractor's State License Law for the
following reason (Sec. 7031.5, B "m s 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).:
(_ 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 (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 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/28/05
Owner:
CALIFORNIA COVE COMMUNITIES
8105 IRVINE CENTER DR. STE.800
IRVINE, CA 92618
Contractor:
CALIFORNIA COVE COMMUNITIE INC
8105 IRVINE CENTER DR STE 800
IRVINE, CA 92618
(949)453-1775
Lic. No.: 811053
------------------
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 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 become su ect to the workers' compensation laws of California,
and a ee that, if I should become su t to t ers�tion provisions of Section
37tof the Lab ode, f _ with comply a�groyy
WARNING: FAILURE TO SEC WORKERS' COMPENSA•.ON COVERAGE IS UNLA FUL, AND SHALL
SUBJECT AN EMPLOYER T IMINAL PENALTIES AND CIVICNDRED 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. 1 agree to comply with all
city and co u ty ordi ances and state laws relating to bu'Id' constructs , ereby authorize representatives
of this cou y to ter upon the above-mentioned pro rt .i r o es.
Dat � �ignature (Applicant or Agent): Ir
I
LQPERMIT
Application Number . . . . . 05-00002620
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 15.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 250
Expiration Date . . 12/25/05
Qty Unit Charge Per
Extension
BASE FEE
15.00
----------------------------------------------------------------------------
Special Notes and Comments
10, L.F. 6' BLOCK WALL, ORCO SYSTEM
Fee summary Charged Paid
-----------------
Credited
Due
--------------------
Permit Fee Total 15.00
----------
.00
----------
.00
15.00
Plan Check Total .00
.00
.00
.00
Grand Total 15.00
.00
.00
15.00