05-2626 (BLCK)`ti O. l�
OX 1504
78-495 CALLE TAMPICO
LA OUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Appljcant:
.05-00002626
81775 BROWN DEER PARK
767-540-014- -
WALL/FENCE
GOLF COURSE
250
T,iht 4 e(P4"
Architect or Engineer:
J(a
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONT CTOR'S DECLARATION
1 hereby affirm under penalty of perjury that I am license,06nder provisi Chapter (commencing with
Section 70 ) of Division 3 of the Busin an rofe ovals Cod my Lic nse is i, full force and effect.
License Claks: 13/ ,.Licevtfe No.: 811 -,'
I hereby affirm under penalty of pelju6 that I am exempt frenr�or'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 ($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.).
(_) 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
Owner:
CALIFORNIA
8105 IRVINE
IRVINE, CA
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
COVE COMMUNITIES
CENTER DR. STE.800
92618
Contractor:
CALIFORNIA COVE COMMUNITIE
8105 IRVINE CENTER DR STE
IRVINE, CA 92618
(949)453-1775
Lic. No.: 811053
INC
800
Date: 6/28/05
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 fo 's permit is issued, I shall not employ any
person in any manner so as to become s act to pensation laws of California,
andee that, if I ome sub' to the r e ' om ns tion provisions of Section
37 of the Labor ode, I she # ith c ly with those v ions.
�✓ Gc
Da cant:
WARNING: FAILURE TO SECURE RS' (; MPENS V•ERAG S UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI AL PENALTIES AND CIVIL FINES 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 informals is correct. I agree to comply with all
city and county ordinances and state laws relating to Fbrildiin onstru n, and hereby a esentatives
of this c my t nter up the above-mentioned proy fo nsp s n purpose
Da Signature (Applicant or Agent):
LQPERMIT
Application Number .
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date .
. . . . 05-00002626
WALL/FENCE PERMIT
15.00 Plan Check Fee
Valuation
12/25/05
.00
250
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 Pa -id 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