05-4152 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-00004152
Property Address: 81877 COUPLES CT
APN: 764 -060 -041 -
Application. description:
64-060-041-Application.description: WALL/FENCE.
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2725
.Applicant:
T4ht °F4Qum&
Architect or Engineer:
r� /A
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/19/05
Owner:
BIRDIE HOMES III; LLC
P) 300 E. STATE ST. STE. 100
^/ LA QUINTA, CA 92253
I hereby affirm under penalty al"perjury that I am licensed under provisions of Chapter'9 (commencing with
Section 7000) of Division 3 of the Business'and ProfessionalsCode, and my License IsIn'full force and effect.
License Class: - B nsa 60044
Date��Contractor:
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a,permtt.to
construct, alter,. Improve, demolish, or repair any structure,. prior to its issuance, also requires the applicant for the
permit to filea signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the. Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged, exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penay of not more than five hundred dollars (8500)::
I, as owner of the property, or my employees with wages as their, sole. compensation, will do the work„and
the structure isnot 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 through his or her own employees, provide&that the
improvements are:not inttended,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:I..
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contraciors' State License Lew 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 LawJ.
(_ 1 .I am' exempt under Sec: , BAP:C. for this reason
Date: Owner:
CONSTRUCTION LENDINO.AGENCY
I hereby affirm under penalty of perjury that there Is a construction lending agency for theperformence of the
work for which this permit Is issued (Sec. 3097,, Civ: C.).
Lender's Name:
Lender's Address:
Contractor:
FIRST PACIFICA DEV CORP
300 EAST STATE ST; SUITE #100
REDLANDS, CA 92373
(909.).798-3688
Lic. No.: 760044
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penaltyof perjury one of the following declarations:
_ I have and will maintain a certificate:of'consem'to self -insure for workers' compensation, as provided
for by Section 3700 -of the Labor Code, for the performance of the Work for which thispermit is
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the.workJor which this permit is,issued. My workers: compensation
insurance carrier -and policy number are: -
Carrier STATE FUND Policy Number
issued, I shall not employ 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;workars' c mpensatfon provisions of Section
3700 of the Labor Code, I shall forthwith ply ith th rovisions. '
ate:� plicant:
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 (8100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is 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 persori'at:whose request and for
whose benefit work is performed under or pursuant to any permit Issued as a resuRof 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
performed underor following issuance.of this.permlt.
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 -for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree wcomply with all
eityand county ordinances and state laws relating to building construction, and hereby authori a presentatfvea
of this,59unty to enter upon she above-mentioned property for inspection perp
ate, � gnature (Applicant:or Agent)
Application Number . . . . . 05-00004152
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 54.00 Plan Check Fee .00
Issue Date . . . Valuation . . . . 2725
Expiration Date . . 3/18/06
Qty Unit Charge Per Extension
BASE FEE 45.00
1.00 9.0000 THOU BLDG 2,001-25,000 9.00
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Special Notes and Comments
109 L.F. 6' GARDEN WALL, CITY STANDARD
Fee summary Charged Paid Credited Due
Permit, Fee Total 54.00 .00 .00 54.00
Plan Check Total .00 .00 .00 .00
Grand Total 54.00. .00 .00 54.00
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