04-5974 (BLCK)`may 444"
BUILDING & SAFETY DEPARTMENT
P.O. BOX 1504 (760).777-7012
78-495 CALLE TAMPICO '' FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . .
Property Address . . . . .
APN:
Application description . . .
Property Zoning . . . . . . .
Application valuation . . .
04-00005974
81954 COUPLES CT
764-060-006-77 -28983 -
WALL/FENCE
LOW DENSITY RESIDENTIAL
4025
bate- 8/19/04
Owner Contractor
BIRDIE HOMES III LLC ;FIRST PACIFICA DEV CORP
300 E STATE #100 300 EAST STATE ST, SUITE #100
REDLANDS CA 92373 REDLANDS CA 92373
(909) 798-36.88
WCC: STATE 'FUND
WC: 00083532004 01/01/'05
CSLB: 760044 03/31/05
CCC': B
Permit. . . . . . .. WALL/FENCE PERMIT
Additional desc
Permit Fee 7.2.00 Plan Check Fee .00
Issue Date . . . . Valuation .. 402.5
Qty Unit -Charge Per Extension
BASE .FEE 4 5. 0 0
3.00 9.00.00 THOU BLDG 2,001-2.5,000 27.00
Special Notes and Comments
161 LF 6' BLOCK WALL PER APPROVED
PRECISE GRADING PLAN AND CITY STANDARD.
Fee summary Charged
Permit Fee Total 72.00
Plan Check Total .00
Grand Total 72.00
Paid Credited Due
:00 .00 72.00
.00 .00- .00
.00 .00 72.00
AUG 27 2004
CITY OF LA QUINTA
P.O. BOX 1504•4 4 � VOICE (.760) 777-7012
78-4.9'5 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 9.2253 INSPECTIONS (760) 777-71.53
BUILDING & SAFETY DEPARTMENT
Application Number: 6 !i� .r� 74 Date: FS '.27 - C4
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
D �14
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that.l am licensed under provisions of Chapter 9 (Co mencing with Section 7000) of Division 3 of the Business and Professionals
Code, and m Lice is in full4arce and effect.
License Class .I>L�e No: cc14
Beate /Cormacto,:F -A, Lffd L
OWNER -BUILDER DECLARATION,
I hereby affirm under penalty of perjury that I am exempt.trom the Contractors' 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 Contractors' State License Law (Chapter 9 (commencing with Section 7000] of Division 3 of the Business
and Professions Code) or that he of she is exempt therefrom and the basis,for the alleged exemption. "violation of Section 7031.5 by any applicant for a pem*A subjects
the applicant to a civil penalty of not more than five hundred dollars ($500):):
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 (Sec.. 7044,
Business and Professions Code: The Contractors'°State License Law does not apply to'an owner of,properly who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that thwimprovements 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 notbuild or.improve for the purpose of sale.).
U I, as owner of the,property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Businessand 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.).
U I am exempt under. Sec. , BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
1 hereby affirm underpenalty 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, forthe performance
�of the work for which this permitu issued.
1 have and wili,maintain workers' compensation insurance, as required by,Section 3700 of the labor Code; for the performance of the work for which this permit is
ad. Jdy w s' cor1I ensation ' ante carrier and olic��(( number a JJ
'farrier. � _ � V\i\ -Policy Number ��
any person in any manner so as to become subject.to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensationprovisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
WARNINb: FAILURE 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 3708 OF THE LABOR CODEJNTERtST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjjury that.there is a construction lending agency for the performance of the work for which.this permit is issued (Sec. 3097, Civ. C.).
Lendees Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the. Director of,Building and Safety fora permit subjectto the conditions;and restrictions set forlhon this application.
1. Each person' upomwhose 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, andthe applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of Le Qulnta. 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 1 have read this application and state that theabove.infortn ones oorect. 1;agree to comply with all city and county ordinances and state laws relating to building
construction, and hprebyauthorize representatives,of this cou ant t
r n OnT
ve-mentioned property forinspection purposes.
ate
/7-74� ignature (Applicant or
i '