05-2578 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:-
Property
umbersProperty Address:
APN:.
Application description:
Property Zoning: '
Application valuation:
Applicant:
05-00002578
52520_AVENIDA VILLA .
773-304-001.-2-000000-
WALL/FENCE
COVE RESIDENTIAL
6250
Architect or Engineer:
a 1►A
^' VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY. DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/24/05
Owner:
DOUG BIRDSELL,
52520 AVENIDA VILLA'
LA QUINTA, CA 9.2253
In ,
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury tha m licensed underprovisioris of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busin i d o ssianaIs Code, and my License.is in full force and effect.
License Class: B License N 811293
OWNER -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, 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.).
( ) 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.).
(_) 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:
LQPERi11IT
Contractor:
BIRDSELL BUILDERS, JOSEPH
P.O. BOX 680
LA QUINTA, CA 92247
(760)360-2301
Lic. No.: 811293
-----------------------------------------------
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 ROSTEN INS Policy Number 2292649105
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so as to become s jest to the workers' compensation laws of California, -
and agree that, if I shout bec a ubject o the workers' comp nsation provisions of Section
3700 of the Lab r de! s II f hwith mply with those provi ns. ,
WARNING: FAILURE TO SECUR WORKERS' OMPENSATION COVERAGE IS UNLA FUL, 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 applicatiori becomes null and void if 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 cancellation.
I ceitify that I have read this application and state that the �abov inf mation is correct. I agree to comply with all
city and county ordinances and state laws relating to ildingc stru ion, and herebyorize representatives
of this county to enter upDn the above-mentioned rap 1� for spec t purpos
�Plate:�—Z� i use (Applicant or Agent):
Application Number 05-00002578
.Permit WALL/FENCE PERMIT
„
Additional desc ...
Permit Fee 9.0.00
Plan Check
Fee
00
Issue Date . . . .
Valuation
. . .
. 6250
Expiration Date 12/21/05
Qty Unit Charge Per
Extension
- BASE FEE
45.00
5.00 9.0000 THOU BLDG 2,001-25,000
45.00
- - - - special ivotes and i'onutiemr s .
- "
250 L.F. 6' GARDEN WALL, CITY STANDARD
Fee summary Charged Paid
Credited
Due
Permit Fee Total 90..00•
.00
.00
90.00
Plan Check Total .00
.00
.00
.00
Grand Total 90.00
.00
.00
90.00
LQPERAIIT -
•ifs
Bin # _
r
City of La Quints +.
' Building a -Safety, Division
P.O. -Box :1504, 78495 Calle Tampicor °
La Quinta', CA 92253- (760) 777-7012
Building Permit• Appiication' and 3r 'Ck1ng Sheet
Permit.#
-
Project Addresss2s-z D u t' !// L t,i1 =
Owner's Name:
A."P. Number: r L
Address:
Legal Description:
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City, ST, Zip:
Contractor: n S
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Tele hone•`
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Address -
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Project. Description:
City, ST, Zip: /—A �y /�JP/a 92�i'4l %r
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Telephone: GCJ �(J, .70
State Lie: # :
-CityLic. #: F
Arch. Engr.;: Designer a
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Address: .
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City' ST, Zip:
Telephone:
Constru_ ction.Type. , ' Occupancy:
State Lic. #:
Project type (circle'one)' "New. A-dd'n Alter, -Repair Demo `
Name of Contact Person: Ve->vr-lyl 1 i V L''G `�
Sq. Ft.: '.
# Stories <A
#Units: "
Telephone # of Contact Person:
p '� if J ad': %d.
t. .,
Estimated Value of Project '•; �' '
APPLICANT: DO NOT WRITE BELOW THIS LINE r w
#
Submittal .
Req'd ,
Rec'd
+` _ TRACKING,
PERMIT FEES
Plan Sets'
f
Plan Check submitted
"Item
n. Amount
Structural Calcs.
Reviewed, ready'for corrections.
Plan CAeck Deposit
Truss CAIcs: ",:
Called Contact Person
Plan Cbeck Balance -
Energy Calcs.
Plans picked up
:Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan
2"u Review, ready for corrections/issue t
Electrical "
Subcontactor List '
Called Contact Person
Plumbing,
Grant Deed
Plans picked up,
S.M.I.
H.O.A. A
s .
-
Plans resubmitted
...
Grading
IN HOUSE:-
'"' Review` read' for corrections/issue
y
' t�,.•
Developer Impact Fee, .
Planning Approval •
Called Contact Person,=
Pub. Wks. Appr
}
Date of permit issue
`
School'Feesr
..
k
Total Permit Fees
0