06-1223 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA .92253
T4tyl 4
ul�tiGv
BUILDING & SAFETY DEPARTMENT
BUIFNG PERMIT
6/
Application Number: r 06-00001223
Property Address: 56198 PALMS DR
APN: 764-020-020-
Application description: WALL/FENCE ,!
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 1525
� 6
Applicant: Architect or Engineer: 0
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B LicenseNo.: 760044
Date: ontractor:
OWNER -BUILDER DECLARATION
I 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 permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a 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'penaltyof not more than five hundred dollars ($500).:
1—) 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 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, 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.).
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractorsto 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.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty, of perjury that there 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:
LQPERMIT
Owner:
BIRDIE HOMES
300 E. STATE STREET, #100
ADLANDS, CA 92373
tractor:
RST PACIFICA DEV CORP
300 EAST STATE ST, SUITE #100
REDLANDS, CA 92373
(909)798-3688
Lic. No.: 760044
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/24/06
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -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.
I have and.will maintain workers' compensation insurance, as required by Section 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number W613-4291
I certify that, in the performance of the work for which this permit is 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 workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith comply with those provisions.
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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety fora permit 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 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 Quinta, 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 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 will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of tt aunty to enter upon he above-mentioned property for inspection purpo e
aU t nature (Applicant or Agentl'
i
Application Number . . . . . 06-00001223
Permit . .
. WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . .
37.00
Plan Check
Fee
.00
Issue Date . . .
.
Valuation
. . .
. 1525
Expiration Date
9/20/06
Qty Unit Charge Per
Extension
BASE
FEE
15.00
11.00 2.0000
HND BLDG
501-2,000
22.00
----------------------------------------------------------------------------
Special Notes and
Comments
LOT 20 - 61 L.F.
6' GARDEN WALL,
CITY
STANDARD
Fee summary
------------------
Charged
----------
Paid
Credited
---------------------
Due
Permit Fee Total
----------
37.00
.00
.00
37.00
Plan Check Total
.00
.00
.00
. .00
Grand Total
37.00
.00
.00
37.00
LQPERMIT
P.O. Box 1504
78-495 CALLE TAMPI'CO
LA QUINTA, CALIFORNIA, 92253
VOICE (760)777-7012 j
FAX (760) 777-701 1 c ./
INSPECTIONS (760) 777-7153
BUILDING &`•SAF'ET.Y DEPARTMENT
Application' Number:
Applicant:
Applicant's Mailing Address:
"FICA G%/0 if
Date: /.•�' OS
Architect or Engineer:
-Arc Engineer's -Address:
1..1ic. No.:
BUILDING; PERMIT.DECLARATIONS :-
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Licer,}s2)is in full force and effect. ^�
.Xicense*Class y� License No!/ ' /
�e . T j i Contractor / ,C. T �RCritC -
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 construct, alter, improve, demolish, or repair any structure, pnorto its issuaince, also requires the applicant for the perrnit4o file a signed
statement that he cr she is licensed pursuant to the:provisions of the Contractors' State LicenseLaw•(Chapter. 9 (commencing with.'Section 7000) of Division 3 of the Business
and,Professions Code) or that he or she is exempt iherefrom'and the basis for the alleged exemption. Any diolatio-,of Section 7031.5 by any applicant for a permit subjects
the applicant'to a civil penalty of not more than five hundred dollars ($500).):11 n
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 guilds 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,saje. If, however, the building or improvement is
sold within one year of completion, the owner -builder will hale the burden of proving thatJheor she did•not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting 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.).
C_), I am exempt under Sec. , BA P.C. for this reason `
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers', compensation, as provided for bySection 3700 of the Labor Code, for the performance
of the work for which this permit.is issued.;.
I have and will maintain workers' compensation insurance, as required bySection 3700 of the Labor Code, for the performance of the work for which this permit is
Jss �vly y+erkers' ompensation insurance came,_and, I' --y nu e5
�Carner_ S(L tv� Policy Number✓
I certify that, in the performance of the•work for which this permit is issued 1 shall not employ any person in any manner as to become subject to the workers'
compensation laws of California, and agree,that, if l should become subject to;the workers' compensation provi
forthwith comply with those provisions. sions of Section 3700 of the Labor Code; I shall
✓Date
WARNING: FAILURE TO SECURE WORKERS' CQMPENSATION.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 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 perfonnance.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 dfBuilding and Safety for a permit subject to:the,conditions andrestnc6onssel:forth on this application.
1. Each person upon whose behalf this app6cafion,is made each person..at whose request andfor whose benefit work 'is`performed under or pursuant to any permit
issued asoma result of this application; the'owner",I'and the applicant; each agrees to, ari6 shall, defend] indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or ,ornission related'to the work'being performed under or f
ffiollowing issuance of.,this'perrmit.
2. Any permit issued as,a result of this.applicationbecomes null and void.if work isnot commenced within 180 days from date of issuance of such permit, or
cessation of work for 166;days will;subject.permit to cancellation..
ation°and state_that the above information is correct. I agree to complynwith all city and•county ordinances and state laws relating to building
I certify that I have read this applic
construction, and hereby authorize representatives of this countyto enterupon the above-mentioned property for inspection;piirposes.
Da t¢ ✓ •�l-%C�,J ✓ � e
Signature (Applicant or Agent):
�F �dZ�rw
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . . 05-00000688 ` Date
Property Address . . . . . . 56198 PALMS DR
APN: 764-020-020- - -
Application description ELECTRICAL
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 2000
2/28/05
Owner Contractor
------------------------ ------------------------
BIRDIE HOMES FIRST PACIFICA DEV CORP
300 E. STATE STREET 300 EAST STATE ST, SUITE #100
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 . . . . . . ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . . 30.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 15.0000 EA` 'ELEC TEMPORARY POWER POLE 15.00
----------------------------------------------------------------------------
Special Notes and Comments
TEMP POWER POLE
Fee summary Charged Paid Credited Due
----------------- ---------- ------ - --- ---------- ----------
Permit Fee Total 30.00 .00 .00 30.00
Plan Check Total .00 .00 .00 .00
Grand Total 30.00 .00 .00 30.00
D ll
MAR 14 2005
I CITY OF LA nc� A —