05-2621 (BLCK)4 P� . B10X 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
Date: 6/28/05
Application Number: C 05-00002621 D Owner:
Property Address: 81715 BROWN DEER PARK CALIFORNIA COVE COMMUNITIES
APN: 767-540-008- - - G 8105 IRVINE CENTER DR. STE.800
Application description: WALL/FENCE O IRVINE, CA 92618
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 250 < C9
ntractor:
Applicant: Architect or Engineer: CF Q(�� ALIFORNIA COVE COMMUNITIE INC
OF�N�q 8105 IRVINE CENTER DR STE 800
IRVINE, CA 92618
(949)453-1775
(/ Lic. No.: 811053
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of ter 9 (commencing with
Section 7000%f Diyision 3 of the Busines Pro onals Code, s is in full force and effect.
License Clay' B Licens 1
r
r OWNER -B ILDER DECLARATION /
I hereby affirm under penalty of p r hat I am exempt fr the Contractor' p�e License Law for the
following reason (Sec. 7031.5, u ' ess and Professions Code: ny 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 _ 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.).
I—) 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: lift
LQPERMIT
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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 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 f which this permit is issued, I shall not employ any
person in any manner so a becom ct to�orkers' com sation laws of California,
and agree that, if I shoul bec e t to thet to the workr a ion provisions n provisions of Section
3700 the Labor Cod , Is I it omply with s ns.
scant:
WARNING: FAILUR TO SECU RKERS' COMPENSATI N COVERAGE IS UNLAW L, AND SHALL
SUBJECT AN EMPLOYER TO NAL PENALTIES AND CIVIL NDRED THOUSAND
DOLLARS ($100,000). IN ADDITI N 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 infor !-Id
is correct. I agree to comply with all
city and cou no rdi ances and state laws relating to nstr tion, and hereby a resentatives
of this co y o ter u he above-mentioned pr pe r ins tion urposes.
D nature (Applicant or Agent):
Application Number . . . . . 05-00002621
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
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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
LQPERMIT