05-0323 (BLCK)O
BUILDING & SAFETY DEPARTMENT
X (760).777-7012
-OF a 78- TAMPICO FAX (760) 777-7011
D B 0 8Q2MTA LIFORNIA 9.2253 INSPECTION REQUESTS (760) 777-7153
FE UPJ BUILDING'PERMIT
GI FIP��C� OEPT.
App i Number . . . . . 05=,0.0000323 Date 1./31/05
Property Address . . . . . . 81830 COUPLES' CT
APN: 764-060-049- - -.
Application description WALL/FENCE
Property Zoning . . . . . LOW DENSITY RESIDENTIAL.
Application,valuation . . . . 3725
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 .92373
(909).798-3688
WCC: STATE FUND
WC: 0008353-2.005 01/01/0,6
CSLB: •760044 03/31/05
CCC: B
Permit . ... . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 63.00 Plan Check Fee .00
Issue Date. Valuation . . . . 3725
Qty Unit Charge Per Extension
BASE FEE 4.5.00
2.00 9.0000 THOU BLDG -2,001-25,000 18.,00
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Special Notes and Comments
149 L.F. 6' BLOCK WALL, CITY
STANDARD.
Fee summary
Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
63.0'0 .00
.00 ..00
:63-.00 .00
Credited -Due
.00 .63.00
.00 . .00
.00 63.00
P.O. Box 1504 VOiCE (760) 777-7012
78-495 CALLS TAMrtco FAX (760) 777-7011
LA QUiNTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7.1.53
BUILDING & SAFETY DEPARTMENT
Application Number: Date: 2 —8 -d zl�
Applicant: - I Architect or Engineer:
Applicant's Mailing Address:
e TO
Architect or Engineer's Address:
Lic. No.:
- BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'SDECLARATION
I hereby affirm underpenaity of perjury that I;am licensed under provisions of Chapter 9 (ocmmen ng with Section, 7000) of Division 3 of the Business and Professionals
Pocle, and my Licen n full foroe:and effect
/;•
se Class n Licensed
I OWNER -BUILDER DECLARATION
I,hereby affirm under penalty of perjury that 1 am exempt from the ContrectoW State License Law for the following mason,(Sec. 7031.5. Business and Professions Code: Any
city or county thatsrequires a permit to constrict, atter, improve, demolish, or repair:any structure, prior to Its issuance, elso'requires the applicant for the. permitto file a signed
statement that he or she is licensed pursuant to the provisions:of the Contractors' 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. Anyviolation of Section 7031.5 by any applicant for a pemrit subjects
the applicant to a civil penalty of. not more than five hundred dollars ($501)):):
U I, as owner of the property, or my.employees with wages as their sole compensation, will do the work, and the structure is notintended or offered for sale (Sec. 7144,
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 intendedor 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-thet he or she did not build or Improve for the purpose of sale.)..
U 1, as ownerof the property,:am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and'ProfesstonsCode: The Contractors'
State.License Law does not apply to.an owner of property who builds or improves thereon, and who contracts1br the projects with a contractors) licensed pursuant to
the Contractors''State License'Caw).
U I am exempt underSec. , B.&.P.C.. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I heieby affirm under penalty of perjury one,of the following declarations:
_ I have and will maintain a certificate of consent to seti 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.
41 have and will main in work compensation insuranceas required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
rk
plWop insurance came
Carrier Policy Number
_ I certify that; in the performance of Wie work for which this pennit is issued. I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of.Califo a, and ag that; if l shthe Labor Code, I shall
torthvXith comply thosgprvisions: o become subjectto the workers' compensation provisions of Section 3700 of
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS.UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER'TO CRIMINAL{PENALTIES AND
CIVILFINES UP TO ONE HUNDRED THOUSANDiDOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FORM'
SECTION 3706 OF THE LABOR CODE, INTEREST,, AND ATTORNEY'S FEES.
CONSTRUCTION LENDINGAGENCY
I hereby aflirn`under penalty of perjury thatthere is a. construction lending agency for the performance of the work for which this permit Is Issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a penrdtt subject to the conditions and restrictions set forth on this application.
1. Each. person upon whose behalfthis 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, and shall, defend. indemnify and hold harmless the City of La.Qutnta, its
officers, agents and employees for any act or omission related to the work being perfomred 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 data of issuance of such permit, or
cessation of work for180'days will subject permit to cancellation.
I certify that I have read this application and state that the atxme i rnallon to comply with all city and county ordinances and state laws relating to building
construction, a he by authorize representatives of this coun enter u a honed property for inspection purposes.
Bate Signature (Applicant orAge