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08-1130 (BLCK)P.O. BOX 1504 -4 78.95 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T&f 4 4 Qu&& BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 08-000,01130 Owner: Property Address: 77169 CASA DEL SOL HARTWELL A. BURNETT APN:. 773-960-015- - - Property Zoning- MEDIUM DENSITY RES Application valuation: 4330 Applicant: Architect -or Engineer: l� --------------------- - -------------------------- LICENSED ONTHACTOR'S DECLARATION 1 haroyaffirm under penahyof perjury .I am I' sed under°provisions of Chapter 9 (commencing with Section 7000). of, Division 3 of the Busi and Pr essio Is:Code, and my License is in full force:and'effect. Licerise'Class: _ B ! License No.: 793216 OWNEWBUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law forthe following reason(Sec. 7031.5, Business and Professions Code: Any city or county that'requires a permit to construct,,aher, improve; demolish, or repair any structure,, prior to its issuance, also re quires applicant for the permit to file,a signed statemamthat he orsheis licensed pursuant,to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division,3 of ",Business and Professions Code) or that'he or she is exempt therefrom and the,basis forthe alleged exemption. Any violation of Section 7031,50y any applicant for a'permit subjects.the applicant to,a civil penalty of not more than five hundred dollars (4500).: (_ 1 1; as owner of the property, or my employees with wages as their sole compensation will do the work, and the structureis not imendedoroffersdfor sale (Sec. 7044, Business.and Professions Code. The Contractors' State License Law does not applyto-an owner of property who builds or improves thereon, and who does the work himself or herself through his.or her own employees, providsd.that;the improvements are net intended: or offered _for sale. If, however, the building or improvement is, sold within one year of completion, thwowner-builder will have the burden of proving that he or she did not build or improve for the purpose of`sale.). ( _:) 1„as owner of the property, am"exclusively contracting with licensed contractors to construct the project (Sec., 70",, Business and Professions Code: TherContractors' State License Law does not apply•to'an owner.of property who builds orimproves thereon, and who contracts for the projects with a contractor(s) licensed pursuant,toithe Contractors' State License Law.). (_) I am exempt under Sec. , B.&RC. 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: Contractor• FISHER CONSTRUCTION INC, DA P.O. BOX 1772 LA QUINTA, CA 92247 (760)771-2161 Lic. No. 793216 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/02/08 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of,*jury-orie of the following declarations: I have,and�will maimaima certificate of consent.to self -insure for workers' compensation;, as provided forrby>Section 3700 of the.LaborCode, for -itis 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 forty ich this permit.is'issued. My workers' compensatlon insurance carrierand policy number are: Carrier STATE FUND Policy Nd,. r. -3006414-2008 I' certify that„in the performance of the wor f r w this permit permit. is issued, I shall not employany person inany manner,so becomebjtheworkers' compensation laws,of California, and agree that, if'I sho me su i a workers, compensation provisions,of Section 3700 of the; Labor C- p l "all fo rth iitply with those provisions. �/ -I -N- WARNING:. FAILU EE SECURE WORKERS' OMPENSATION COVERAGE S UNLAWFUL, AND SHALL SUBJECT AN EMPLOY,ERTO CRIMINAL PENALTIES AND'CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS Is 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 herebymade;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,resultof this application; the owner, and the applicant, each agress•to, and shall defend, indemnify and hold harmless the City of `La Quints, its officers, agents and employees for, any act or o6/hefr” lated to the work being performed,underor following issuance of this,permit. 2 Any permit.issued as a result'of this application becomes null anork is not commenced wRhin 180 days from date of issuance of such permit, or ceasark.for f60 days will subject permit to cancellation. fcertifythat I have read this aDPlicetidn and state that the. v informatio 1 agree tocomply with all city and county ordinances and state laws,releting to buil c n ruction, authorize representatives of this-co}wRyto enter upon the above-mentioned props ar prgtion Sj re (Applicant or Agent):. Application Number . . . . . 08-00001130 Permit . . . WALL/FENCE PERMIT Additional desc . . Permit Fee 72.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 4330 Expiration Date . . 12/29/08 Qty Unit Charge Per Extension BASE FEE 45.00 3.00 9.00.00 THOU BLDG 2,001-2.5,000 27.00 ---- ------------------------------- Special Notes and Comments 200 L.F. 5•' GARDEN WALL, CITY STANDARD AT SIDEYARD AND COURTYARD Fee summary Charged Paid ---- Credited Due ----------------- ---------- Permit Fee Total. 72.00 .00 :00 72.00 Plan Check Total .00 ..00 .00 .00 Grand Total 72.00 .00 .00 72.00 ORMATION OR LOGATt RNV MHKK ANT IDER6ROUND FACILITIES. I 0 !` . d Vr,rA 10 1111r r am A am 5' SETS :MINIMUM 0) ONE % UTILITIES LOCATION l �2(r WAor yu { I r, A L. POOL. '. � MINIMUM (U ONE �,' .. � �� • • ' AVFM C. �- •� II W x{Y 1 �. r .t �YY _.—. '. _ .. � . •',._..d. �.....iv �7 _ I /%.'''.�.. \ .-_. x.41.— _ _ I �- _ . � . _ ._ ..—.....__�. _ -. ........ � . ��.i K. ..�.r�� .-.......`_ + Bin # Permit # Project Address: A. P. Number -7 73 -,3.1,,o City of La Quinta Building U Safety Division P.O. Boz 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet - &U- Owner's Name: 77-rwe/-4- U cr Tr — Address: � . Legal Description: l e D City, ST, Zip: Contractor: v)!) �tS,�G� �e'ry � e Telephone: Address: 77-/04, cacfProject Description: �j,�.L C 7 City, ST, Zip: Ll ✓/� TAGlut Telephone: State Lic. # : -J Designer: Ctl G�G�S �a2 S S /�, 3� Ae L, T, 6 City Lic. #:1,6D At2Lx}rrA �-o- Address: Q (c4i t ff T V-A c -T 'Z 4 0 City, ST, Zip: P- 6Y� Telephone: Y�0 - 3 Construction Type: Occupancy: State Lic. #: G % Q Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: D14V Lo r, f Doti Sq. Ft.: -# ;Stories: # units: Telephone # of Contact Person: -z S . 3 A3Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE q Submittal Req'd Rec'd TRACIMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cities. Reviewed, ready for corrections Plan Check.Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Cities. Plana Picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2"1 Review, ready for correctioWmue Electrical Subcontactor List Called ContactTerson Plumbing Grant Deed Plans picked up S.M.I. H.OA. Approval Plans resubmitted Grading IN ''' Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit.issue School Fees Eermit Fees