05-1722 (BLCK)BUILDING & SAFETY DEPARTMENT
-, P.O. Box 1504
C
6.0 .777-701
(.7 ). 2
5 CALLE TAMPICO FAX (760) 777401:1
D
UINTA, CALIFORNIA 9225.3 INSPECTION REQUESTS (760:) .777-7.153
MAY 052005
BUILDING PERMIT
CITY OF W fdLlItBTA
tuber
Date 5/05/05
Property Address ..
5364.0 AVEN-IDA-CORTEZ _
APN:
774-102-'007- - -
Application description'.-.'-
WALL/FENCE
Property Zoning . . ..
COVE RESIDENTIAL
Application valuation .
': 1624-
Owner
Contractor
PACIFIC HOMES
PACIFIC HOMES
P-0 BOX 102.3
P.O. 'BOX 1023
LA QUINTA, - CA 92247
LA` QUINTA., CA 92247
(760.).408 -34;95 -
WCC :. STATE' FUND
.WC:: 1576557 08j01/05
CSLB: 7'82.324 08/3,1/06
CCC: B
P.O.. BOX :I 504 41r,
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
O _
Applicant's Mailing Address:
"V*E (760) 777-701`2,,
FAX "(760) 7,77-7011
INSPECTION$ (760)'7.77-71531
Dates X. ,7 ,6U—
Architect or Engineer: -
1
Architect or Engineer's Address:.
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby'affinn under penalty ofpedury that 1 am licensed,under provisions of Chapter 9 (odmmencingWth Section 7000) of Division 3 of the Business and Professionals
Code, and my_Ltgttep0irVful11Qi;ps,,and effect. -e!j
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that 1 am exempt from the Contractots''State Lioanselaw for fhe following reason (sec. 7031.5, Business.and Professions Code: Any
city'or county that requires'a permit to construct, alter, improve, demolish, or repairany:stnttxure, prior to its issuance; also requires the applicant for the permit to file 'a signed
statement that he or is licensed pursuant to the provisions of the Contractors' State License Law (Chapter g (ooritmenaing with Section 7Q00) 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 fora pennit:subjects
the applicant4o a civil penaltyof not more than five hundred dollars ($500).):
U I; as owner of the property, or.my employees with wages; asrtheir sole compensation,. will do.the work; and the structure is notintended or offeredfor sale (Sec, 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improvesahereon, and who does the work
himself o.r, herself;or through his or her own employees, provided that4ieimprovements,are not intended or offered forsale. If,'however,.the building orimprovement is
sold within one year of completion, the owner -builder will have the burden of proving that hemrshe did not build:or improve for the,purpose of sale.).
U 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 Lawdoes not apply to an owner of property who builds or Improves thereon, and who contracts forthe projects with a contractors) licensed pursuant to -
to Contractors' State License Law.).
U I am exempt under Sea BA P.C. for this reason
Date
WORKERS' COMPENSATION.DECLARATION
1 hereby affirm, under penalty of perjury one of theJollowing 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 apd 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
�J I certify that, in'llie performance: of :wor_k which)lhis Permit is issdid.4stitill not employ any person in any manner so as to.beeome-subject to the workers'
compensation laws of California, and agree that.:irlshould become subject to the.workers' compensation provisions of Section•3700 of the Labor Code, l shall
forthwith comply.with those provisions.
Date �4s+pticG_� tk�"T�J
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODEj INTEREST, AND ATTORNEY'S FEES.
CONSTRUCTION LENDING AGENCY
I herebyaHinn 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. CJ.
Lender's Name.
Lenders Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is herebymade tothe Director of, Building and Safetyfor a permit subject to the conditions and restrictions set forth on this applicatiom
1. Each person upon whose behalf this application,is made, each person at whose request and'for whose benefit work is performed under or pursuanf-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 Quints, its
officers, agents and employees forany-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 void' if work is not commenced within 180 days from date of issuance. of such pemut, or
cessation of work, for 180 days will subject permit to cancellation.
I certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and.state laws relating to building
construction, and hereby authorize, representatives of this county jg enter upon the above-mentioned property for inspection purposes.
Application Number . . . . . 05-00001722
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Permit . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 39.00 Plan Check Pee .00
Issue Date . . . . Valuation . . . . 16.24
Expiration Date . . 11/01/05
Qty Unit Charge Per Extension
BASE FEE 15.00
12.00 2.0'000 HND BLDG 501-2,000 24.00
Special Notes and.Comments
75 LF 5' BLOCK WALL PER CITY STANDARD.
2U01 CBC
Fee summary Charged
Permit Fee Total 3.9.00
Plan Check Total .00
Grand Total 3.9.00
Paid Credited Due
.00 .0-0 39.00
.00 .0'0 .00
.00 .00 39.00