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04-5962 (BLCK)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLE TAMPICo FAX (760) 777-7011 LA QU.INTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 . BUILDING PERMIT Application Number0'4 ;:00005'9-6. Date 8/18/04 Property,Address 56222 VILLAGE DR APN: 764-040-017-' - - Application description WALL/FENCE i Property Zoning 'LOW DENSITY RESIDENTIAL Application valuation 4025 -Owner: Contractor - '. BIRDIE HOMES III LLC FIRST PACIFICA DEV CORP 300.E STATE -ST # 100 300 EAST.STATE ST, SUITE #100 REDLANDS CA 92373 REDLANDS CA 92373 (909),,798-3688. WCC: STATE FUND WC; 0.0083532004,. 01/01/05 CSLB: 760044 03/31/05 CCC: B Permit WALL/FENCE PERMIT Additional.desc Permit Fee . . . 72.00 Plan Check Fee .00 Issue Date Valuation 4025 Qty Unit Charge Per Extension. BASE FEE 3.00 9.0000 THOU BLDG, 2, 0,01-25,000 7 27.;00 Special Notes and Comments 161 LF 6' BLOCK WALL PER APPROVED PRECISE GRADING PLAN AND CITY STANDARD. Fee summary Charged .. Paid. Credited Due Permit Fee Total 72.00 .00 .,00 72.0'0 Plan Check.Total 00 00 .00 00 Grand Total, 72.00 .00 .00 72.00 P.O. BOX 1504 " VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: 25 Architect or Engineer: 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 3 of the Business and Professionals C de, and my Lice �is in full force and effect. p V1,� cense Class License No. 7 C) ©"t Date l ontractor l i 1,'-,= Pte{r1CA OWNER -BUILDER 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 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 Contractors' 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).): 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 or herself 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 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.). U I am exempt under Sec. , B.& P.C. for this reason Date Owner WORKERS' 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. J' 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 w rkerr��,,compensation in�+rence carrier and pol'c nu ber are: er - [� 1j11 ,1\ o icy Number(/ ��-ZC�"j�. _ 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 subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ate pp4 IC rantZR S WARNING: FAILURE TO SECURE WORKERS' 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. 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 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, indemnity 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 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 certify that I have read this application and state that the above i formatio 's correct. Ila ee to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize of this cou enter u o the ab o oned property for inspection purposes. DateVZ 71n-11 Signature (Applicant or A t):