04-5976 (BLCK)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 . . . . . 04-00005976 Date 8/19/04
Property Address . . . . . . 81914 COUPLES CT
APN: 764-060-008-79 -2:8983 -
Application description . . . WALL/FENCE
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation 4025
Owner Contractor
-- - - - - - - - - - - -- -- -} --.r--� -- - - - --- 2�---+.``.4 .
BIRDIE HOMES III LLC FIRST PACIFICA DEV CORP-
300
ORP300 E STATE ##100 300 EAST STATE ST, SUITE 4100
REDLANDS CA 92373 REDLANDS CA 92373
(909) 798 -3 688
WCC: STATE FUND
WC: 0.0083532004 01/01/05
CSLB: 760044 03/31/05
CCC: B
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Permit . . . . .. . WALL/FENCE PERMIT
Additional de'sc .
Permit. Fee 72.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 4025
Qty Unit Charge Per Extension
BASE FEE 45.00
3.00 9.0000 THOU BLDG.2,001-25,000 27.00
Special Notes and Comments
161 LF 6' BLOCK WALL PER.APPROVED
PRECISE GRADING PLAN AND ,CITY STANDARD.
.Fee summary Charged Paid Credited Due
Permit Fee Total 72.00 .00 .00 72.00
Plan Check Total .00 .00 .010 .00
Grand Total 72.00 ..0'0 .0,0 72.00
Q�
AUG 2'7'2004
CITY of LA QUINTA
FINANCE DEP
P.O. BOX 150VOICE` (760) 777-701.2
78-495 CALLE TAMP I 4 CO FAX (760) 777-7011
LA QUINTrA, CALIFORNIA 92,253 INSPECTIONS (760) 777-7153
BU"ILDING' & SAFETY DEPARTMENT
Application Number: 04' 4%97&
&
Applicant:
Applicant's Mailing Address:
Date: �'S-aZ-1-0
Architect.or Engineer:
Architect or Engineer's. Address:
Lic. No.:
SVA
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirnund enalty of perjury that"I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division3 of the.Business and Professionals
Ogen and "my Lice s" in full force and effect. . eQ� 44
rcense Cuss icense No.
OWNER-BUILDEWDECLARATION
I hereby affirm' under penalty of perjury that I am exemptfrom'the Contractor:' 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 Mat he.or she'is licensed pursuant to the provisions of the Contractors' State License Law (Chapter.9 (commencing with Section TOM) ,of Division 3 of the Business
and Professions Code) or thathe or she is exempt therefrom and the basis for the alleged exemptlon: Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not morelhan 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 structureis not Intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractors' State License Law does notapply 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 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 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 (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of 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. , B.8 P.C. for this; reason
'Date. Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one ofthe'following declarations: _ thave and will maintain a.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 and will maintain workers' compensation insurance, as required by Section 3700 ofthe Labor Code, for the performance of the work for which this permit is
My vCAers' co ensattan i nce;camer
mer 4- /1 �_.pcy Number
I certify that, in the performance of the work for which this -permit is issued, I shallnotemploy any person.1nmanymanner so as to become subjectto the workers'
compensation laws of California, and agree that, if 1 should become subject to.the workers', compensation provisiomof Section 3700 of the Labor Code, t shall
'forthwith comply with those.provislons.
M— L�
WARNING: FAILURETO'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'GOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR, CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penaltyof perjury that there is a construction lending agency forthe performance of the work for which this per ft;is issued (Sec: 3097; Civ. C.).
Lender's Name.
Lender's Address 04
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Applicatiomis hereby made.to the. Director of Building and Safety for 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:atwhose request and for whose benefit works performed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, eacWagrees to, and shall, defend, indemnify and hold harmless the City of La Quinta,.fts
officers, agents,and.employees foranyactor omission related.to the work being.performed under or following Issuance of this permit.
2. Any permit issued as "a•resul of. Biis" application becomes null and void 7f v+ork 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:
U certify that I have read this application and state.th4aboveforma isco agree to"comply"with all city and county ordinances and state laws relating to building
construction and h rebyautho ntatives o ente u a ntloned propertyfor inspection purposes.
Date Signature (Appiicant o