05-2946 (BLCK),P,.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
X05-00002946 1:
78880 CITRUS
772-101-008-
WALL/FENCE
LOW DENSITY RESI
2625
c&,ht 4 4 Quiftm
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect o
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LICENS CO RACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am I sed nder provisions of Chapter 9 (commencing with
Section 7000) of Di ' n he Busin4 and P fe sio als Code, and my n full fgrc effect.
License Class: License No.: (f% / lj
te: _7- ntract ,
OER- LDER 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 penalty of not more than five hundred dollars ($500).:
(_) 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 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, 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 contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ ) I am exempt under Sec. , 8.&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:
LQPEnIIT
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:
1 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 numb are: Q/,11r/-F9 ��tYl
Carrier CS C27 C29 C53 I lic umber fi
I certify that, in the performance of wor or which this permit is issued, I shall not em oy any
person in any manner so as to be o sub ct to the workers' compensation laws of California,
and agree that, if I sho becom sub) o the workers' compensation provisions of Section
3 0 of the Laboorr e 1 shall f hwi omply with those provisions.
ate. SoPlicanC
WARNING: FAILURE TO SECURE W RKERS' CO N 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 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 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 n vo if work is not commenced
within 180 days from date of issuance of such permit, or c sat n work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the ve inform ion is or ct. I agree to comply with all
city aWlw/i
ordin nces and state laws relating to buil constructi ,and at by authorize representatives
of thi o enrupon the above-mentioned grope y r insp do purpos
Da e: Signature (Applicant or Agent):
t Application Number . . . . . 05-00002946
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 54.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 2625
Expiration Date 1/11/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
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Special Notes and Comments
15•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 54.00 .00
.00
54.00
Plan Check Total .00 .00
.00
.00
Grand Total .54.00 .00
.00
54.00
LQPERMIT