04-5975 (BLCK)Tar °f 4 Q"
P.O. BOX 1504
78-495 CALLE. TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . . 0.4-00005975 Date 8/19/04
Property Address . . . . 81934 COUPLES CT
APN: 764-060-007-78 -28983 -
Application description . . . WALL/FENCE
Property Zoning . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 4025
Owner Contractor
BIRDIE HOMES III LLC FIRST PACIFICA DEV CORP
300 ESTATE #100 300 EAST STATE ST, SUITE #100
REDLANDS CA 92,373 REDLANDS CA 9237.3
(909) 798-3688
WCC: STATE FUND
WC: 00083532004 01/01/05
CSLB:. 760044 03/31/05
CCC: B
Permit . . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 72.00 Plan Check Fee .00
Issue Date Valuation . . . . 4025
Qty Unit Charge Per Extension
BASE FEE ,, 45.00
3..00 9.0040 THOU BLDG -2, 0,.01-2'5, 000 27.00
Special Notes and Comments
16.1 LF 6' BLOCK WALL PER APPROVED
PRECISE GRADING PLAN.AND;CI'FY STANDARD.
.Fee summary Charged Paid Credited Due
Permit Fee Total 72.00 .010 , a0 72.00
Plan Check Total .00 .00 .00 .00
Grand Total '72.00 .00 .00 72.00
P.O. Sox 1504 •� VOICE (760) 777-7012
7.8-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-71.53
BUILDING & SAFETY DEPARTMENT
Application Number: 04- % Date: —Dc4
Applicant:
Applicant's Mailing Address -
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
A)1Aq
BUILDING PERMIT DECLARATIONS
LICENSEO'CONTRACTOR'S DECLARATION
I hereby affirm under enalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division.3 of the Business and Professionals
Code, and my Licens in full force and effect.
., ' ccense Class 1 , nse No2Ceno
OWNER43uILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for thefoliowing 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 (Chapter9 (commencing with Section 7006) of Division 3 of the Business
and Professions Code) or thathe oFshe is exempt therefrom and tha.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).):
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 property 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 sold: 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,.ari 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 exemptunder Sec. , B.8 P.C. forthis 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 consent'to sefflnsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
.[ of the work for which this permit is issued:
I have 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
ued, y racers' climpensation.injpance.cemer and rtu r are:
eerier ` E ] NU\ eMcy Number .c�O ��24yo
_ I certify that in the performance of the work for whichthis permft is issued, I shall not employ any person in any manner so as to become subject to thwworkere'
compensation laws of California, and agree that, if I should become. subject to the workers, compensabon provisions of Section 3700 of the Labor Code, l shall
forthwith comply with those provisions.
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 37013 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 perfornanoe of the work for which: this permit is issued (Sec.. 3097, Civ. C.).
Lender's Name OAA Lender's Address NAA
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety1or 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,appbcabon. the owner, and the applicant,;each agrees to, and shall, defend, indemnify and hold harmless the.City of La Quinta, its
officers.egents and,employees for .any actor omission relatedto the"work being performed under or following issuance of this permit.
2. Any permit issued as a resultof•this application becomes null,and void if -work is not commenced within -180 days from date of issuanceof such permit or
cessation of work,for 180 days will subject permit to cancellation. ,
I certify that I have read this,application and state that the above i formation i correct. I to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this conn enter u a:,.
abo ned property for inspection purposes.
/Date S ignature (Applicant or