05-2948 (BLCK)i
P:O. ,BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
---05-000.02948---
78870 CITRUS
772-101-009-
WALL/FENCE
LOW DENSITY RESIDENTIAL
3050
CC) N 7W� C: TFO�
Architect or
Tdy/ 4:NQ"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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LICENSE ACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am Iice7V1ed*un,N provisions of Chapter 9 (commencing with
Section 7000) of Di4�io a Busine s and Profe si Is ode, and my License is in full force and effect.
License Cl a (- / nse No.:
ate: , Contractor:
lj
OWNER•BUI ECLARATION
I hereby affirm under penalty of perjury that I am exem rom a Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions: 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 penalty of not more than five hundred dollars ($500).:
(_ 1 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
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 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.). '
( 1 1 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/15/05
Owner:
CAPITAL PACIFIC HOLDINGS
4100 MACARTHUR BLV STE 200
NEWPORT BEACH, CA 92660
Contractor:
CALIFORNIA POOLS & SPAS
WCC: SEABRIGHT INS
WC: BB1050510 01/01/06
CSLB.- 656128 10/31/06
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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.
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 C8 C27 C29 C53 Policy - - -
I certify that, in the performance of the k for -w 'ch this permit is issued, I s t �e n y any
person in any manner so as to becom bject to he workers' compensation laws of California,
and agree that, if I should ome subje to the orkers' compensation provisions of Section
/ 37 0 of the Lobar Code, s all forthwit with those provisions.
Date:pplicant:
WARNING: FAILURE TO SECURE WORDS RS' COMPENSATI VERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND IVIL F ES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000) IN ADDITION TO THE COST OFC ENSATION, 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 for a 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 fission 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 void work is not commenced
within 180 days from date of issuance of such permit, or ce ati of ork for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above informati n is or ct. I agree to comply with all
_city and county ordinances and state laws relating to ui construction, and reby authorize representatives
of this my o enter pon the above-mentioned p rty r inspe ion p r e .
D e: ure (Applicant or Agent):
Application Number . . . . . 05-00002948
Permit. . . . . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee . . . . 63.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 3050
Expiration Date 1/11/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
2.00 9.0000 THOU BLDG
2,001-25,000
18.00
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Special Notes and Comments
32 L.F. 6' BLOCK WALL, CITY STANDARD
AND 90 L.F. 6' BLOCK WALL, ORCO
SYSTEM.
Fee summary Charged
Paid
Credited
- - - -
- ----
Due
-- - - - - - -
-- - - - - - - - - - - - - - ------ - - - - ---
Permit Fee Total 63.00
--- - - -
- -----
.00
.00
63.00
Plan Check Total .00
.00
.00
00
Grand Total 63.00
.00
.00
63.00
LQPER IrT