05-2627 (BLCK)P.O. `BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
05-00002627
Property Address:
81785 BROWN
APN:
767 -540 -015 -
Application description:
WALL/FENCE
Property Zoning:
LOW DENSITY
Application valuation:
250
X
DEER PARK
RESIDENTIAL
Architect or E
P //I
Tit4t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirmunder penalty of perjury that I am lice ed under provisions apter 9 (commencing with
Section 70 O) of Di ision 3 of the Busin d P essionals Code, se is in full force and effect.
License C ss: B License- 110
,-6-at ontractor:
OWNER -8 ER DECLARATION
I hereby affirm under penalty of A(that exempt from - - e 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).:
(_) 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.).
I_ 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: ItQ
Lender's Address: � 141
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
24
issued.
ave 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 mann�C�
come sub" t to the ers' compensation laws of California,
and re e that, if I sub' the workers' c ion provisions of Section
t 3 0 of the Labor comply with se pro ' s.
I.
a i�pplicant: ice'
WARNING: FAILURE TO S ORKERS' OMPENSATI COVERAGE IS UNLAW L, AND SHALL
SUBJECT AN EMPLOYER CRIMINAL PENALTIES AND CIVIL TO ONE HU RED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, D S 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 ation of work for 1,80 days will subject
permit to cancellation.
I certify that I have read this application and state tha a inf mation is correct. I o comply with all
city and county ordi nces and state laws relating to buildi co uction, and he uthorize re resentatives
of this co my to a er upon th ove-mentioned pro pas.
Oa)� '�.' nature (Applicant or Agent •
-4
LQPERMIT
Application Number
Permit . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
. . . 05-00002627
WALL/FENCE PERMIT
15.00
12/25/05
Plan Check Fee . . .00
Valuation . . . . 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 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