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05-0313 (BLCK)ox 1504 CALLE TAMPICO [NTA, CALIFORNIA 92253 BUILDING PERMIT Application Number- . Property Address APN: Application.description . Property Zoning . . . . . Application valuation . . BUILDING & SAFETY DEPARTMENT (760)„777-7.017 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 . 05-00000313 Date 1/31/0.5. 81997' COUPLES CT 764-060-035- WALL/FENCE 64-060-035 WALL/FENC-E . LOW DENSITY RESIDENTIAL . 4300 Owner ------------------------ BIRDIE HOMES 111, .LLC. 300EAST STATE STREET, STE 100 0 REDLANDS CA 92373 Contractor FIRST PACIFICA DEV CORP 300 EAST STATE ST,. SUITE #100 REDLANDS CA 92373 (909) 798-36.88 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 . . . . 4300 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 172 L.F. 6' BLOCK WALL, CITY STANDARD. Fee summary Charged Paid Credited Due Permit Fee Total 72.00 .00 .00 72.00 Plan Check Total .00 .00 .00 .00 Grand Total 72.00 .00 .00 72.00 P.O. BOX 1504 • Qawfij VOICE (,760) 777-7012 78-495 CALLS TAMPICO FAX (.760) 777-7011 TLA QUINTA, CALIFORNIA 92253 INSPECTIONS (760).777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: 2 - '0 S Applicant: Applicant's Mailing Address: Architect or Engineer. Architect or Engineer's Addre s: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty,otpedury that,l am•licensed under, pnovisions'of Chapter -9 (commencing with Section 7000) of Division 3 of the Business and Professionals e, and myLicende 'n full force and effect. ©d nse Crass n License�Vo.�_ OWNER -BUILDER DECLARATION I hereby affirm 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 construcL alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for the_pernitto file a signed statement fhat 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 .allegad exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appticantto a civil penalty of not more than five hundred dollars (S500).)a 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 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 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 exciusivelyoontracting 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 property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U 1 am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a,lcertificate of consent to self -insure for workers' compensation, as provided for bySection3700 of the Labor Code, (or the performance of,the work for which this permit is issued. 1 have and will ma' tain wo rs' compensation insurance, as required by. Section 3700 of the Labor Code, for the performance of the work for which this permit is u rs' com sation insurance came an Cerrier Policy Number _ 1 y that in the performance of the worts for which this pe ' is issued, I shall not employ any person in any manner to as to become subject to the workers' compensation Iaws,of California, a d ag t,;if I s ulme subject to the workers' wmpensatlon provisions of Sedibn 3700 of the Labor Code, I shall �fforti mply with those p ns. Date �/Applicant WARNIN FAILTO 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 COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN SECTION 3708 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 torthe performance of -the work for which this permit isjssued (Sec. 309.7, Civ. C:). Lender's Name fi / / Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety fora permit subjectto 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 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, indemnity and hold harmless the City of La Ouints, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any pernitissued'as a resull'of this application becomes nuitand void,if work is not commenced within 1804ays from date of issuance of such permit, or cessation of work for 180 days will subject permit to ncellati . I certify that I have read this application ve nn ab and state that the aboab s nee to comply with all city and county ordinancesand state laws relating to building con nand reby authorize representatives of this cou to enter time tioned property for inspection purposes. Dale Signature (Applicant or t :