05-0315 (BLCK)S
BUILDING & SAFETY DEPARTMENT
O. Box 1.504 (760).777-7012
'3 495: CALLE. TAMPICO FAX (760) 777-7011
LA
FES QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 7774153
C,Tr . aE�T a BUILDING PERMIT
F%04
Application Number . . . . . 05-00000315 Date 1/31./05
Property Address . . . . , . 81977 COUPLES CT
APN: 764-0.60-036- - -
Application description . . . WALL/FENCE
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . 36.25
Owner Contractor.
BIRDIE HOMES 1.11, LLC FIRST PACIFICA DEV CORP
300 EAST STATE STREET, STE 100 300 EAST STATE ST, SUITE #100
R:ED,LANDS CA 92373 REDLANDS CA'.92373
(909) 798-3688
WCC: STATE FUND
WC: 6008353=2.005 01/01/06
CSLB: 760044 03,/31/05
CCC: B
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Permit.�. . . . WALL/FENCE PERMIT
Additionaldesc
Permit Fee 63.00 Plan Check Fee .00
Issue Date Valuation . . . . 3625
Qty Unit Charge Per Extension
BASE FEE 45..00
2.0,0 9.0000 THOU BLDG 2, 0 01-2;5 , '000 18.00
Special Notes and Comments
145 L.F. 61.BLOCK WALL, CITY
STANDARD.
Fee summary
Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
63.00 .00
.00 0.0
63. 00 .0.0
Credited Due
.00 63.00
.00 .00'
.00 63.00
P.O., Box 1504 VOICE .(760) 777-701'2
78-495 CALLE TAMPICO FAX (760) 777-70.11
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY' DEPARTMENT'
Application Number: Date: 0-00-0S-
Applicant
—-0SApplicant: I Architect or Engineer:
Applicant's Mailing Address-
.
Architect or Engineer's Address:
Lid. No.:,
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTO_ R'S DECLARATION
I hereby affirm under penalty of perjury that lam licensed under provisions of Chapter 9 (Pon1mencingmIthLSeC60n 7000) ofDivision 3 of the Business and Professionals
b�oodde, and'my Lic�lr s in full force and eBe
t/Lmense Class T-1 n� License lye.
OWNER-BLILDER:DECLARATION;
" I hereby affirm under penalty of perjury that;l am exempt from the ContractoW-State License Law for the following reason (Sec. 703,1.5. Business and P.rofesAm Code: Any
city or countythat re4uires a permit to construct, atter, improve, demolish, or repair any structure, prior to gs issuance, also requires thwapplicent for the permit to file a signed
statement thathe.or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter9 (commencing: with Secdon'7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom andthe besisforthe alleged exemption., Any violation of Secti0n..7031.5by sny applicant fora pernit'subjects
the applicant to a civil penalty of not more than five. hundred dollars (5500)))-
U 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 (See. 7044,
Business"and°Professions Code The Contractors' State License Law does'not.apply town owner of property who builds or improves thereon,and who does Ute work
himself or herself or through his or tier"oWn. employees, provided that the improvements are not intended or offered for sale. H, however, the building orimprovement is
sold within one year of completion, the owner -builder will have the.burden of proving that he or she did notbu(Idorimprove for the purpose of sate:).
U I, as owner of the property, am exclusively contracting with licensed contractors to,constnrct the project,(Sec. 7044,. Business and Professions Code: ThcContractors'
State License. taw 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
theZontracton,V State License Law.).
U 1'am exempt under Sec. BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION_
1 hereby affirm under penalty of perjury one: of the following declarations:
_ I have and will maintain a certificate ofoconsenf to selfansure for workers' compensation:: as provided for by Section •3700 of the LaborrCode„for the performance
of'the work for which this,permit is issued.
I have and will Lain work ' compensation insurance, as requiredibyiSection 3700 of the Labor Code, for the peAornance of the work,for which this pemUt is
rs' comp tion insurancerri(
'
Cae Policy Numbea r
certifydhat, in the performance of the work for which this permit is' issued„ 11 shall not employ any persorrin anymanner so as to become subject4o the workers -
compensation laws of'Cslifomia, an& t, if I,should become subject to the workers', compensation provislons of Sectibn 3700 of the Labor Code, I shall
fort comply with those p ions.
Appli n
WARNING: "FAILURE TO SECURE,WORKERS'-COMPENSATION COVERAGE IS UNLAWFUL,.AND SHALL SUBJECT ANtEMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE'COSTOF COMPENSATION,.DAMAGES.AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penattyof perjury that there Is a construction lending agency.for,the performanceof,the work for which'this permit is issued (Sec. 3097, Civ.. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT'Application:is hereby made to the Director of Building and Safety "for a pam* subject to the conditions and restrictions set forth on:ttus 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 pursuantto any pam t
issued as,a result of this applicetion,�the owner, and the applicant, each agrees to, and shall, defend, indemnify and. hold harmless the City of Le Quints, Its
officers, agents and employees for any actor omission related.to:the work being performed under or following'issuance of this permit
2. Any permit issued assua
a result of application becomes nu_I1,and void`ifwork isnot commenced within 180 days date, of such permit. or
oessationof workJor 180 days will .subjecLper mh to cancellation.
tcertifythatL have read this application and state that the above info on is t;a to comply with al city and'countyordinances and state laws relating to, building
construction, and'herebyauthorize representatives. of this county to er upon tinned
_ % propertyforinspection ,purposes.
v Date Signature (Applicant or Agen