05-0317 (BLCK)Tar
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
00 BUILDING PERMIT
OF�G�
l.icat-ion Number . . . . . 05-000010317 Date 1/31/05
Property Address . . . . . . 81937 COUPLES CT
APN: 764-060-038- - -
Application description . . . WALL/FENCE
Property Zoning . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 3150
Owner Contractor
------------------------ ---- -----------------
BIRDIE HOMES 111, LLC FIRST PACIFICA DEV CORP
300 EAST STATE STREET STE 100 300 EAST STATE ST, SUITE #100
REDLANDS CA 92373 REDLANDS CA 92373
(909) 798-3688
WCC: STATE FUND
WC: 0008353-2.0015 01/01/06
CSLB: 760044 03/31/05
CCC: B
Permit . . . . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee, 63.00 Phan Check Fee .00
Issue Date . . . . Valuation . . . . 3150
Qty Unit Charge Per Extension
BASE FEE 45.00
2.00 9.0000 THOU BLDG 2,001-25,000 18.00
Special Notes and Comments -
126 L.F. 6' BLOCK WALL,, CITY
STANDARD.
Fee summary.
-------------------
Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
63.00 .00
.00 ..00
63.00 .00
Credited Due
.00 63.00
.00 .00
.00 6.3.00
P.O. Box. 15.04•� VOICE (760) 777-7012
78-495 CALLS TAMP.ICO FAX 1(760) 777-70'11
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDINQ tit SAFETY DEPARTMENT
Application Number: Date: Z - 8 ' 0 S'
Applicant: I Architect or Engineer:
Applicant's Mailing Address
Arb-hitect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm undo enatty,of perjury that I am licensed and provisions o Chapter 8 en
(com cing`with•Section 7000) of DivisionZof the,Business and Professionals
e, and my Liven to full force and effect.
License Class rise No
,,/Date Contract
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5. Business and Professlons Code: Any
city or county that requires a permit to constrict, sitar, 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 pursuantto 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 orshe'Is exempt therefrom and the'basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects
the applicantto a civil, penalty of not more than five hundred dollars ($500);):.
r
U I, as owneof 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 ofproperty who builds or Improves,thereon, and who does the work
himself or herself or 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-buitder will have the burden of proving that he or she did not build or improve -for 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.).
U I am exempt underSec. , BA P.C: for this reason
Date. . Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirm under penalty of peduryone of the following declarations:
_ I'have and will maintain a certificate of consent,Wseif insurefor workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work 'for which this permit is issued.
1 have and will m 'ntain wo ars' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
cs M wo ers' com sation Insurance demi , I er
/Carrier �CL-X. Policy Number ;
in anymanner sous to become subject to the workers'
compensation laws of Califomialandiagrep that. If I shotdd become subjectWthe,workers' compensation provisions of Section 3700 of the,Labor'Cods. I shall
forth 'th comply wkhthose. sions.
,/Date S App ice
WARNING: 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. CODE, INTEREST, AND ATTORNEY'S.FEES.
CONSTRUCTION LENDINGAGENCY
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
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a perm 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 isrperformed under or pursuantto 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 Quints, Its
officers, agents and employees;for any act or omission related to the work being perforeed.under or following issuance of this permit.
2. Any Permit Issued as a result of this application becomes null and void if work"isnot commenced within 180 days.from date of issuance of such permit, or
cessation of work for180:days will'subject permit to canoeilabon.
I certifythat I have read this applicationend,state that the above `nforrmall -1s correct ree to comply with all city and countyordinances and state laws relating to building
C�istruction, and he y authorize representatives,of this co u t enter n the a ntioned property. for Inspection purposes.
V/111
/ /Date, Signature (Applicant or A