05-2787 (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:
05-00002787
78890 CITRUS
772-101-007-- -
WALL/FENCE
LOW DENSITY RESIDENTIAL
2382
CoNT/ eA C T 0)e
T4ht 4 4 Q"
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lice sed under provisions of Chapter 9 (commencing with
Section 7000) of Diyiaion 3,git Busines nd Pro nals Code, and my I,,r'ce�ye�s ip ff angrr� d effect.
License Class: license No.: �j� (fly �i
Date: A 6 Contractor: 4'
NER•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 penalty of not more than five hundred dollars ($500).:
(_ I I, as owrier 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 contractorls) licensed
pursuant. to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
V Date: Owner:
CONSTRUCTION LENDING AGENCY
1 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:
LQPERA11T
Date: 7/07/05
-----------------------------------------------
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 CS C27 C29 C53 Policy Number
_ I certify that, in the performance of the work for which tHis permit is issued, I shall not ploy any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should becoAstolhe workers' compensation provisions of Section
370XX0 of the Labor Cod shallomly with those provisions.
�u�Applicant
WARNING: FAILURE TO SECURE RKERS' 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 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 an ' if work is not commenced
within 180 days from date of issuance of such permit, or cess on 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 c rre . I agree to comply with all
city and county ordinances and state laws relating to buildin onstruction and h r y authorize representatives
of this county o e0er upon the above-mentioned propert fo inspe tion urp s.
Date>�-l�to. ignature (Applicant or Agent):
Owner:
CAPITAL
PACIFIC HOLDINGS
4100 MACARTHUR BLV STE 200
Dn
NEWPORT
BEACH, CA 92660
JUL 111005
ontractor:
ALIFORNIA POOLS & SPAS
CITYOFLAQyily1'q
CC:
SEABRIGHT INS
F1JyCe
WC:
BB1050510 01/01/06
CSLB:
656128 10/31/06
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lice sed under provisions of Chapter 9 (commencing with
Section 7000) of Diyiaion 3,git Busines nd Pro nals Code, and my I,,r'ce�ye�s ip ff angrr� d effect.
License Class: license No.: �j� (fly �i
Date: A 6 Contractor: 4'
NER•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 penalty of not more than five hundred dollars ($500).:
(_ I I, as owrier 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 contractorls) licensed
pursuant. to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
V Date: Owner:
CONSTRUCTION LENDING AGENCY
1 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:
LQPERA11T
Date: 7/07/05
-----------------------------------------------
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 CS C27 C29 C53 Policy Number
_ I certify that, in the performance of the work for which tHis permit is issued, I shall not ploy any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if I should becoAstolhe workers' compensation provisions of Section
370XX0 of the Labor Cod shallomly with those provisions.
�u�Applicant
WARNING: FAILURE TO SECURE RKERS' 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 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 an ' if work is not commenced
within 180 days from date of issuance of such permit, or cess on 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 c rre . I agree to comply with all
city and county ordinances and state laws relating to buildin onstruction and h r y authorize representatives
of this county o e0er upon the above-mentioned propert fo inspe tion urp s.
Date>�-l�to. ignature (Applicant or Agent):
Application Number . . . . . 05-00002787
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee 54.00
Plan Check
Fee
.00
Issue Date
Valuation
2382
Expiration Date 1/03/06
Qty Unit Charge Per
J
Extension
BASE
FEE
45.00
1.00 9.0000 THOU BLDG
2,001-25,000
9.00
----------------------------------------------------------------------------
Special Notes and Comments
20 L.F. 5' BLOCK WALL, CITY STANDARD
AND 90 L.F. 5' 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
LQPEnHT