05-2387 (BLCK)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Application Number:
OS -00002+387
Owner:
Property Address: j111k7890.0
APN:
CITRUS
772-101-006-
- -
a
CAPITAL PACIFIC HOLDINGS
4100 MACARTHUR BLV STE 200
D
Application description:
WALL/FENCE
NEWPORT BEACH, CA 92660
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1000
;CITy
2005
iLAi
QUINTA
Contractor:
Applicant:
Architect or Enginee :
FINANCEOEPT.
CALIFORNIA POOLS & SPAS
WCC: SEABRIGHT INS
CC)/T&C /0
It `�
WC: BB1050510 01/01/06
CSLB: 656128 10/31/06
LICENSEn CONTRACTOR'S DECLARATION
I ereby affirm under penalty of perjury that I a icense under provisions of Chapter 9 (commencing with
action 7000) of ialsioD.3 a the Bu ' ess and fessio als Code, and icgfis� iejfi fVl or�E�end effect.
vv✓✓✓✓ License Cla s:
Date: � Contract
OWN ILDER 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).:
(_ 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 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 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
Date: 6/16/05
----------------------------------------------—
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 foi 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 Rimply
I certify that, in the performance ofhich this permit is issue , 1 shall not ploy any
person in any manner so as to bo the workers' compensation laws of California,
and agree that, if I s becom workers' compensation provisions of Section
3790 of the Labor od I shall with those provisions.
pplic t: .
WARNING: FAILURE TO SECURE W RKERS' COM 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 or omi related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes II nd void if rk is not commenced
within 180 days from date of issuance of such permit, or c tion of wo for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the ova informs ion is c I agree to comply with all
city and county ordinances and state laws relating to bu' ing constructio , and h authorize representatives
of this u toe er upon the above-mentioned prop rt insp coon as
D �V.4nature (Applicant or Agentl.
Application Number . . . . . 05-00002387
Permit . . . WALL/FENCE
PERMIT
Additional desc . .
Permit Fee . . . . 25.00
Plan Check
Fee
00
Issue Date . . . .
Valuation
. . .
. 1000
Expiration Date . . 12/13/05
Qty Unit Charge Per
Extension
BASE
FEE
15.00
5.00 2.0000 HND BLDG
501-2,000
10.00
----------------------------------------------------------------------------
Special Notes and Comments
40 L.F. 6- BLOCK WALL, CITY STANDARD.
Fee summary Charged
-------------------------------------
Paid
Credited
--------------------
Due
Permit Fee Total 25.00
.00
.00
25.00
Plan Check Total .00
.00
.00
.00
Grand Total 25.00
.00
.00
25.00
LQPERMIT