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05-0322 (BLCK)Ti4 4 14 a9wai BUILDING & SAFETY DEPARTMENT :),X 1504 (760).777-7012 CALLE TAMPICO FAX (760) 777-7011 INTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT ober . . . . . s I . . . . Li'YlV Application description ._ Property Zoning .. Application valuation . 05-0000032.2 Date 818.16 COUPLES CT 764-060-048- - WALL/FENCE LOW DENSITY RESIDENTIAL 4425 1/31/05 Owner Contractor BIRDIE HOMES 111, LLC FIRST PACIFICA DEV CORP 300 EAST.STATE STREET STE'10.0 300 EAST STATE ST, SUITE #100 REDLANDS CA 92373 REDLANDS CA 92373 (909) 798-3688 WCC: STATE FUND WC': 0008353-2005' 01/01/06 CSLB: .760044 03/31/05 CCC: B Permit . ... . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 72.00 Plan Check Fee .00 .Issue Date . . . . Valuation . . . . 4425 Qty Unit Charge Per Extension BASE FEE 4.5.00' 3.00 9.0000 THOU BLDG -2,001-2.5,000 27.00 Special Notes and Comments 177 L.F. 6' BLOCK WALL, CITY STANDARD. Fee summary ------------------ Permit Fee Total Plan Check Total Grand Total Charged Paid Credited -Due. 72.00 .00 .00 72.00 .00. .. 00 .00 .010 72.00 .00 .00 72.00 P.O. BOX •1504 • VOICE (760) 777-7012 78-495 C'ALLE TAMPICO FAX (760) 777-7011 LA QU'INTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153, BUILDING & SAFETY D-EPARTMENT Application Number: Date: Z' �� -0 S - Applicant: Applicant's Mailing Address: �n li Architect or Engineer: Architect or Engineer's Address: Lic. No.:. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (c mn ewng with Becton 7000) of Division 3 of the Business and Professionals ode, and my Liven in full force and effect. ✓ License Class � 1 Licise Na i© �M ME OWNER43UILDER DECLARATION y I hereby under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031 .5. Business and Professions Code: Any city or county that requires a permit to construct aiter,,.improve, demolish, or repair any stricture, prior,to its Issuance, also requires the applicant for the; permit to filie,a signed. statement that he or, she is licensed'pursuant to the provisions of the ContreciotiV State License Law. (Chapter 9 (commencing with Section 7000) of DM. Mon.3 of the Business and Professions Code) or that he or she is exempt thamtrom;and-the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the.applk:ant to a civil penalty of not mom thar:five hundred dollars ($500):): U 1, 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 Professions- Code: The CohiractoW State License Law does not apply to an ownerof,propeity 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 improvernent1s sold within one year of completion, the owner -builder will have the burden of proving that he or did not build or Improve for the purpose of sale.). U I, as owner of the property, am emfclusivelycontracting with licensed contrectorsto eonstiuct:the.project(S,ec. 7044, Business and Professions` Code: The Contractors' State License Law does notapply to anowner rof property'who builds -or Improvesi thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the ContractorsState'L'icense Law.). U I Am exempt under Sec. B.& P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of.pequry one of the following declarations: I have and will maintain a certificate of consent to self4risure for workers' compensation, as provided for by Section 3700 of the Labor Code, :for ilha pe nce of the work for which'tfiis pernitiwissued. I have and will main in workers' compensation Insurw2edmi required by Section 3760 of the Labor Code, for the performance of the work for which;this permit is ed rk pert�pon insurance carn /carrier � � Policy Number _ I certity that, in the performance. of the work- for which this permitle Issued, I shall no employ'any person Irizarry manner so as to bebome:subject b the workers' compensation laws.of California, and ag that, H ould become subject to the workers' compensation provisions of Seaton 3700 of the Labor Code, I shall tort. V th comply with thos%prjpvis(ons. �� 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 ($100,001)), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708' OF THE LABOR CODE, INTEREST, AND ATTORNEY'SFEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a.construclion lending°agency forthe performanoe of the work for�which this pennitis issued (Sec. 3097, Civ. C.). Lenders Name 4 4 ,C� Lenders Address / ` APPLICANT 'ACKNOWLEDGEMENT IMPORTANT Application is hereby made tothe Director of Building and Safety for a.pennit subject to the conditions and restrictions set forth on this application; 1. Each person upon whose behalf this application is made, each person at.whose request.and.tor whose benefit work is performed under or pursuant to any permit issued sea result of,this application, the owner, and the applicanteach agrees to;and shall, defend, indemnify and hold harmless the City of Le Quints, its i officers; agents and employees for any act or omission related:to he.work.being performed 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 180 days from date of issuance of such permit, or cessation of:work for 180 days wifi, subject permit to can lation. 1 certify that 6 have read this application and state that the above rmeton Is 1 e to comply with Zrcity and county ordinances and state laws relating to building ConstructioWndrebyauthorize representativesof this coun_ t ter upon , orad' property foinspector purposes.DateSignature (Applicant or'Agen : n