05-1166 (BLCK)BUILDING & SAFETY DEPARTMENT
0 L 0 (760).777-7012
-49�TA co FA. X (760) 777-7011
IN FpRNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Applicat io)k Kumber . . . . 6 Date 3/29/05
Property Address . . . . . . 53865 AVENIDA CORTEZ
APN: 774-141-018-7 -000'000-
Application description.. . . WALL/FENCE
Property Zoning . . . . . . . COVE RESIDENTIAL
Application valuation . . . . 3750
,Owner Contractor
.DOUGLAS BI-RDSELLL BIRDSELL BUILDERS, JOSEPH
P.O. BOX 630 P.O. BOX 680
LA QUINTA CA 92247 LA•QUINTA CA 92,247
(760) 360-23,01
WCC: ROSTEN INS
WC: 2292649105 11/22/05
CS"LB: 811293 08/31/05
CCC.: B
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 63.00 Plan Check Fee .00
Issue Date Valuation . . . . 3750
Qty Unit Charge Per Extension
BASE FEE 4:5.00
2.00 9.0000 THOU BLDG 2;00.1.-25,0;00 18.00
Special Notes and Comments
1:50 LF 6' BLOCK WALL PER CITY STANDARD.
FRONT P/L IS LIMITED TO MAX.HEIGHT 51.
Fee summary Charged . Paid
Permit Fee Total 63.00 .00
Plan Check Total .00 .00
Grand Total 63.0,0 .00
Credited Due
.00 63.00
.00 .00
.00 63.00
P.O. BOX 1.504 •� VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 9.2253 INSPECTIO.NS (760) 777-71.53
BUILDING & SAFETY DEPARTMENT t,
Application Number: 0`6 tt G G Date: 3 r 'p R�
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. 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 of the Business and Professionals
Code, and my Lice rs m full force and effect.
Lirs3rrse.Class ri �'tf�ns�`Ne "�� b l
,24y -c4
OWNER43UILDER 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 perrnitto construct, alter, improve, demolish, or repaireny structure, prior to Its issuance, also requires.the applicant for the permit to file.a signed
statement that he br she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing wIh Section 7000) of Division,3 of the Business
and Professions Code) or that he orshe 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).):
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. builds or improves thereon, .and who does the work,
himself orherself or 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.).
U 16. as owner of the property, am exclusively contracting with licensed contractors,to construct the project (Sec: 7044, Business and Professions Code: The Contractors'
State Ucense Law.does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contrador(s).lieensed pursuant to
the Contractors' State License Law.).
U II aim e�xempt,under Sec. & P.C. r this reason
n��e ""lam % n... e � ` >.,., \ / \ � J � � •
\.` WORKERS' COMPENSOATION DECLARATIOTC
I hereby affirm under penalty of perjury on f thefollowing declarations: \\
_ I have and will maintain a certificate of consent to se)14nsure for workers' oompensation, as provided fdr 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 compensap'an4risvrenee sarrier_�
_ I certify that,'in the performance of ft idl-wo _ or WNc?r this permit is issued, I shall not employ any person in any manner so as to become subject to Me workers'
compensation laws of California,. andree hat .rf I•should beoome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those proviftnrl
s \
WARNING: FAILURE TO SECURE WORKEREt COMPENSATION COVERAGE IS: UNLAWFUL, AkD,SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSA D DOLLARS ($100,000).!N ADDITION TO THE COST OF COMPENSATION, DAMAGES.AS PROVIDED FOR IN
SECTION 3708 OF THE.LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I hereby. affirm under penally of perjury that there is a construction lending agency for the performance of the work for which this permi4 is issued (Sec. 3097, Civ: C.).
Lendees Name
Lender's Address
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°atwhose'request and,for whose benefit work is. perforned'under orpursuant Wany permit
issued as a resultof 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 actor 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 voi •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 cancell r n.
I certify that I have read'thrs application and state that the above i fortnati n is rrect. I agree to comply with all city and. county ordinances,and state laws relating to building
construction, and hereby authorize representatives of this tour tc enter pon above-mentioned p rty for inspection purposes.
I.,`
Date �y� '`'� �Signeture,(Appl'icant or Agent): �1 �'