05-0324 (BLCK)BUILDING & SAFETY DEPARTMENT
iO4 (760).777-7012
LE TAMPICO FAX (760) 777-7011
CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application description .
Property Zoning . . . . .
Application. valuation . .
05-01000032.4 Date 1/31/05
81844 COUPLES CT
764-060-0.5,0- - -
WALL/FENCE
LOW DENSITY RESIDENTIAL
6200
Owner Contractor
BIRDIE HOMES I;II, LLC FIRST PACIFICA DEV CORP
300 EAST STATE STREET STE 1.00 300 EAST STATE ST, SUITE #100
REDLANDS CA 92373'REDLANDS CA 92373
(909) 7987-3:688
WCC: STATE FUND
WC: 0008353-2005 01/01/06
CSLB 760044 03/31/05
CCC: B
Permit . ... . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 910.00 P1an.Check Fee .00
Issue Date . . . . Valuation . . . . 620.0
Qty Unit Charge Per Extension
BASE FEE 45.00
5.00 9.0000 THOU BLDG 2,001-25,000 45.00
Special Notes and Comments
248 1L.F. 6' BLOCK WALL, CITY
STANDARD.
Fee summary Charged Paid Credited -Due
Permit Fee Total 90.00 .00 .00 90.00
Plan Check Total .00 .00 .00 .00
Grand Total 90.00 .00 .00 90.00.
P.O. Box. 1504 • VOiCE (760) 777-7012.
78-495 CALLS TAMPICO FAX, (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777=71.53
BUILDING & SAFETY DEPARTMENT
Application Number: Date:
Applicant: I Architect or Engineer:
Applicant`s Mailing Address:
Architect. or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 herebyaffirtrn'under penalty of perjury that -1 am,liFensed,under provisions; hapter9 (nom ncing with Seckm 7000) of Division 3 of ft Business and' Professionals
Code, and my V�eU full force and effect:
License Class �1 - 1 N ucepskNo.
OWNER43UILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractors State License Law for the toliawing reason (Sec. 7031.5, Business and Pmfesskins Code'. Any
city or county that requires a permit, to construct, alter, improve, demolish, or repair any stricture, prior to ft Issuance, also requires the applicant for the pernit.lo.file a signed
statementthat he or she is licensed pursuant to the provislons,of the Contracions' 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 exemptlom Any violation of;Sec8on7031.5 by any applxoent for a permit subjects
the applicant to a civlllpenalty of not more than five hundreddollars{5500).):
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 ProfessionsCode: The Contractors' State License Law does notappiy to an ownerof property who builds T,impnwes thereon, and who does the work
himself or herself orthrough. his or her own employees, provided that the improvements are,notintended 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 1, as owner of the property, am exclusivety contracting with licensed contract= to construct the project (Sea 7044, Business and Pidessions Code: The Contractors
State License Law.doesnotapply to an owner of'property who builds_ or improves thereon, and who contracts for the projects with a contractors) licensed pursuant.to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby affirn'under penalty of pe4ury'one of the following declarations:
_ I have and will maintain a certificate of consent self -insure for workers' compensation, as provided for by:Seclion 3700,0(the Labor Code, for the performance
of the work for which this permit is issued.
V 1 have and will maintain rkers' mpensation insurance, as required by Section '3700 of the labor Code, for the performance of the work for which this permit is
7` sa ed, work rs` m ens n Insurance carr;
_ I certity that
In the perfo ante of work for which this permit is issued, I shell not employ any person in any manner, sor as to become subject to the worlds
compensation laws of California„and ag that If I's Id become subject to the workers' compensation provislons of Sectibn 3700 of the Labor Code, (shall
1fb. comply with those slons.
Date Appli �—�
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER'TO CRIMINAL PENALTIES AND
CIVIL FINES UP TG ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST 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 penalty of perjury that there is a construction lending agency for the performance ofthe work for which1his permit is issued (Sec. 3097,, Civ. C.).
Lender's Name
Lender's Address l
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject lathe 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 application, the owner, and the applicant, each agrees to, andshall, defend; indemnify and hold: harmless the City of La Quints, Its -
offioers, agents and employees for any act or omission related to the work being, perfommed,under or following issuance of this permit
2. Any"permit issued as a result of this application becomes null and void if work is not commenced within 160 days ,from date of issuance of such permit or
cessation of workfor 180 days will subject permit to cancellation.
I certify that I have read this application•and state thatthe above rmation I rect I a to comply with all city and county ordinances and state laws retailing to building
construction, a he by authorize representatives of this coup enter upo 4oned property for inspection purposes.
Date Signature (Applicant or Ag t : n