05-0318 (BLCK)Tar°� �W 13101hefa
Sox 1504
5 CALLE TAMP.ICO
JINTA, CALIFORNIA 9.2233
lber
s
BUILDING PERMIT
APN:
Application description .. .
Property'Zoning .. . .
Application valuation . . .
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
05-010000318 - Date 1/31/0`5
81917 COUPLES CT
764-060,-03'9-
WALL/,FENCE
LOW DENSITY 'RESIDENTIAL
Z875
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 92.373
(909) 798-3688
WCC: STATE FUND
WCi 0008353-2005 01/01/06
CSL'B: 75.0044 03/31/05
CCC B.
Permit . . . . . . WALL/FENCE PERMIT
Additional d'esc .
Permit Fee . . . . .54.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 28'75
Qty Unit Charge Per Extension
BASE FEE. 45.00
1:00 9.0000 THOU BLDG 2,001-2.5,000 9.00
Special Notes and Comments
115 L.,,F. 6''B.LOCK WALL, CITY
STANDARD.
Fee summary Charged
Permit Fee Total 54.00
Plan Check Total .00
Grand Total 54.00
Paid Credited Due
----------
.0,0 .00 54.0 0
.00 .00 .00
.00 00 54.00
P.O: Bok 1.504 i VOICE (760) 777-70:12
78-495 CALLE TAMPICO FAX (766) 777-7011
LA QUINTA, CALIFORNIA 92253, 4INSPECTIONS. (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application. Number: Date:
Applicant: I Architect or Engineer.
Applicant's Mailing Address:
owd m(amm -- -
Architect or Engineer's dress:
/A
Lie.. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under enaity of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division of theBusiness and Professionals
Code, and my Lice in full, force and effect.
✓License Class mse No.
/017
Da t5 Contract _
OWNER41UILDER DECLARATION
I hereby affirm under penalty of,pedury that 1 am exempt-from'the Contractors' State LicenseLaw for the following mason,(Sec. 7031.5, Business and Pro(eselons Codes Any
city or county that requires a permit to construct, alter; improve, demolish, or repaluany structure, prior to its issuance, also requires the applicant for the permit to tile'a,signed
statement that'he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapterg (commencing wp,Sedion 7000) of!Division 3 of the Business
and Professions Code) or that he orshe .is exempVtherefrom andthe basis for,.the alleged.exemption. Any violation of Sectlon°7031:5 by any applicanffor a permit subjects
the applicant to a,civil penalty of notmore than.five hundred dollars ($500jr):;
U I,,as owner'of the;propefty„or my employees with wages as their sole compensation,will do the work, and the structure.is not intended'or offeredfor sale (Sec. 7044,
Business and Professions Code: The Contractors' State License. Law does not apply to an owner of propertywho builds or impmves,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,ithe building,orimprowment is
sold within one year of completion, fhe owner -builder will have the burden of prov'ing,that,he or, she did not build or improve -for Joe 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 contracts4or the projects with a contrador(s) licensed 'pursuant to
the Contractors' State License Law.).
,U I am,exempt under Sec. , BA RQ for this reason
Date: Owner
WORKERS' COMPENSATION DECLARATION
t hereby affirm under penalty of perjury one ofahe following declarations:
_ Lhave and,will maintaima:certificate of consent to.self-insure 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 a will main in works 'compensation insurance, as required by Section 3700 ofthe Labor Code, for the performance of the work for which this permit is
rk mpe bon,insurance carrier
y I cellify thdr`IiTft performance of the work forwhich!lhis permit is Issued, I shall not employ any person imany manner so as to become subject 'to the workers'
compensation laws of California, and agree tket. if I strould' become, subject to the workers' -compensation provisions of Section 3.700 of the Labor Code..) shall
fort¢l M comply those,provipions. I \ J�
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,OOQ), IN ADDITION TO THE COST OF COMPENSATION, DAMAGESAS-PROVIDED FOR IN
SECTIONl3706'OF`THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDIN%AGENCY
I hereby affirm under penalty of,perjury that there is a construction lending agency for the perfornance;of the`work for whieh,this permit is'issued (Sec. 3097, Civ: C.).
Lender's Name
Lendees.Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Applicatiomis herebymade to M6 Director of Building and Safety for permit subject,to the conditions and; astrictions setforth on this application.
1: Each person upon whose behalf this application is made, each+persomat whose request and for whose benefitwork: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. Indemnify and hold harmless the Cityof La Quints, Its
officers, agents and'employees for anyactor omission relatedto the work.being performed under or following issuance of this permit.
2. Any permit issued..aszresultof'this application becomes null and void1f.work is not commenced within 180 days from'date of issuance of such pernit;,or
cessation of work for 180 days will subject permit to cancellation.
I certify thatl,have`read this application and state.that.the above In nnation fs I agree to ply wftallfdty and county ordinances and state laws relating to building
construction,.and: by authorizerrepresentatives of this county jnter upon the b ve-menti property for Inspection purposes.
Date Signature (Applicant orAgen