05-0316 (BLCK)BUILDING & SAFETY DEPARTMENT
x 1504 (760).777-7012
f9 `,�uT8-4 °5 ALLE TAMPICO FAX (7.60) 777-7011
.QUI A, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number 05-0:0000316 Date 1/31/05
Property Address . . . . . 81957 COUPLES CT
APN: . 764-060-037- -
Application description WALL/FENCE
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 3150
Owner Contractor
BIRDIE HOMES 11.1„ LLC. FIRST PACIF.ICA DEV CORP
300 EAST STATE STREET STE 100 300 EAST STATE.ST, SUITE #1.00
REDLANDS CA 923.73 REDLANDS CA 92373
(90.9) 798-36.88
WCC: STATE FUND
WC: 000.8353-2005 0.1/01/06
CSLB: 760044 03/31/05
CCC: B
Permit. . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 63.00 Plan Check Fee .00
Issue,Date . . . Valuation . . 315.0
Qty Unit .Charge Per Extension
BASE FEE 45.00
2.00 9.0000 THOU BLDG 2,001-25,000 18.00
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Special Notes, and Comments
126 L.F. 6' BLOCK WALL, CITY
STANDARD.
Fee summary Charged
Permit Fee Total 63.0.0
Plan Check Total .00
Grand Total 63.00
Paid Credited Due
.00 .00 63.00
.00 .00 .00
.00 .00 63.00
P.O. BOX 1504� VOICE (760) 777-7017
T-Vf
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Date: o
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Ad cess:
Lic. No.:
BUILDING PERMIT DECLARATIONS
.LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 ( m ncing with Section 7000) of Division 3 of the Business. and Professionals
b�oodde; and my Lioe s in full force and effect.
JLtoense Class Licens
Yate Cont
OWNER43UILDER DECLARATION
1 hereby affirm under penalty of perjurythat 1 am exemptirom the Contractors' State License Law for the iollowing reason (Sec. 7031.5; Business -and Professions Code: Any
city or county that requires,a permit to construct, alter, improve, demolish, or repair any stricture, 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 Contractors' State.License Law (Chapter 9 (commencing with Section 7000) of Division 3 ofthe 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
theapplicant to a civil penalty of notmore thah-five hundred dollars ($500)):
U I, as owner of the property„or my employees With wages'as their sole compensation, will dothe work, and the structure is not intended or offered for sale (Sec. 7044,
Business'and Professions Codec 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 or through his or her own employees, provided that” Improvements are not intended.or offered for sale. If, however, the building or improvementis
sold Within one year of completion, the owner -builder will have the burden of proving that he or she aid not build or improve for the purpose of sale.).
U I„ as owner of the property. am.. exclusively contracting with',licensed contractors to construct the project'(See. 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. wkha contractor(s) licensed pursuant to
the,Contractors' State License Law.).
( j .I am exempt under Sec. B.8 P.C. for this reason
Date Owner.
WORKERS'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ i have and will maintain a certificate of consentto seff4nsure for workers' compensation, as provideflorbySection'3700 of the Labor Code, forthe performance
of the work for which this permit is issued:
1 have and will ntain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
wo e ' co sation insurance cam
_ I certify tha , 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 subject to the workers'
compensation laws of Callifo is., and a ttta if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, l shall
fo mply witthh those vision .
112bte Appli
WARNING: F (LURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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.
CONSTRUCTION, LENDING AGENCY
I herebyaffirm 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
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for 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, indemnity and hold, harnless the.City of La Quints, its
officers, agents and employees for any actor omission related to the work being performed under or fo0owing Issuance of, this, permit.
2. Any permit issued as a resuttof this application becomes null and void if work isnot commenced within 190 days from date of issuance ofeuch pemrit, or
cessation.of work for 180 days will subject permit'to ce Ration.
I certify that I have read this application and state that the above rnation is d. Is o ply with all city. and county ordinances and state laws relating to building
construction, and by authorize representatives of thi er upon d. property for inspection purposes.
Date Signature (Applicant or Ag