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08-1942 (SOTB) a IIIIIIIIIIIIIIIIIIIIIIIII 29 IE I4 P.O. BOX 1504 - - - VOICE(760)777-7012 78-495 CALLE TAMPICO FAX(760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING&SAFETY DEPARTMENT INSPECTIONS(760)777-7153 BUILDING PERMIT Date: 12/10/08 Application Number: 08-00001942 Owner: Property Address: 80875 AVENUE 60 R.T. HUGHES APN: 766-110-016- - - 78900 AVENUE 47, STE. 200 Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA 92253 D Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 25060 d Contractor: Applicant: Architect or Engineer: FEDOR MASONRY INC, JAMES 1 l P.O. BOX 1397 LA QUINTA, CA 92247 l" Licol3 036 No. : 823181 N� l - -- - - - - ---- -- -------- ---- - - - - - ---- ----- - - -- --- - - ----- -- --- - - ----- -- --- - -- -- -- - --=---------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000)of Division 3 of the Business and Professionals Code,and my License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers'compensation,as provided License Class: C29 License No.: 823181 for by Sectinn 3700 of the Labor Code,for the performance of the work for which this permit is issued. Date: Contractor: _ 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 OWNER-BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier ENDURANCE AMRCN Policy Number WEN100232501 following reason(Sec.7031.5,Business and Professions Code: Any city or county that requires a permit to I certify that,in the performance of the work for which this ermit is issued,I shall not employ any construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for the person in any manner so as to become subject to the kers'compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that,if I should become subject to thew rs'compensation provisions of Section License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or 3700 of abor Code,I forthwit comply th those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by // J' any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).: atl �/ v plicant: (_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 WARNING: FAILURE TO SECURE WORKERS'COMPEN ION COVERAGE IS UNLAWFUL,AND SHALL Contractors'State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees,provided that the DOLLARS($100,000). IN ADDITION TO THE COST F COMPENSATION,DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If,however,the building or improvement is sold within SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. 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.). APPLICANT ACKNOWLEDGEMENT ( I 1,as owner of the property,am exclusively contracting with licensed contractors to construct the project ISec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044,Business and Professions Code: The Contractors'State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon,and who contracts for the projects with a contractor(s)licensed 1. Each person upon whose behalf this application is made,each person at whose request and for • pursuant to the Contractors'State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1_1 I am exempt under Sec. B.&P.C.for this reason 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. Date: '� '— nar: 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 CONSTRUCTIO NDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construct n lending agency for the performance of the I certify that I have read this application and state that tha ahnve information is correct. I 1yee to comply with all work for which this permit is issued(Sec.3097,Civ.C.). city and county ordinances and state laws relating to building construction,and hereby a •orize representatives of this county to enter u on the a ve-mentioned property fo,i. stun purposes. Lender's Name: gn re(Applicant or Agent): Lender's Address: LQPERA1IT Application Number . . . . . 08-00001942 Permit BUILDING PERMIT Additional desc . Permit Fee . . . . 258.50 Plan Check Fee 168.03 Issue Date . . . . Valuation 25060 Expiration Date 6/08/09 Qty Unit Charge Per Extension BASE FEE 252.00 1.00 6.5000 THOU BLDG 25,001-50, 000 6.50 ---------------------------------------------------------------------------- Permit ELEC-MISCELLANEOUS Additional desc . . Permit Fee . . . 37.25 Plan Check Fee 9.31 Issue Date . . . . Valuation 0 Expiration Date 6/08/09 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 3 .75 1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50 ---------------------------------------------------------------------------- Special Notes and Comments FAUX BRIDGE STRUCTURE AT MALAGA ESTATES ENTRY (ENGINEERED) THIS' PERMIT DOES NOT INCLUDE CURB, GUTTER OR STREET PAVING. 2007 CALIFORNIA BUILDING CODE. APPROVED BY AO FOR JLJ. December 10, 2008 12:42 :23 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STRONG MOTION. (SMI) - COM 5.26 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- --'-------- ---------- Permit Fee Total 295.75 .00 .00 295.75 Plan Check Total 177.34 .00 .00 177.34 Other Fee Total 5.26 .00 .00 5.26 Grand Total 478.35 .00 .00 478.35 LQPERA11T