09-0876 (ELEC)P.O.-BOX 1504
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78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253: BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
09-00000876
52225 SILVER STAR TR
767-20.0-999-13 -312021-
ELECTRICAL
LOW DENSITY RESIDENTIAL
500
Architect or Engineer:
146 4v `
LI NSED CONTRACTOR'S DECLARATION -
I hereby affirm unc!Wpenalty of perjur that am licensed under provisions of Chapter 9 (commencing with
Section, 7000) of Division 3 of the Busi ess d Professionals Code, and my License is in full force and effect.
Lice nsPey"CI S. B License No.: 753190
Date/ �`/ � Contractor:
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).:
1 _ 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
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
t improve for the purposeof sale.). _
(- ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. -
7044, Business and Professions Code:T Contractors' State License Law does not apply to an owner of
property who builds or improves there d who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State Lice L w.).
( I I am exempt under Sec. , B.&P.C. r his reason
f i
Owner:
I hereby affirm under penalty of perjury that there is
work for which this permit is issued (Sec. 3097, Civ
Lender's Name:
Lender's Address:
LQPERMIT
RUCTION LENDING AGENCY
construction lending agency for the performance of the
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153.
Date: 8/14/09
Owner:
DESERT CHEYENNE,- INC. O
78401,HIGHWAY 111, SUITE G O
LA QUINTA, CA 92253
(760)'777-9920
Contractor:, �� •�J�,...
HERINGTON DEVELOP J All
40960 CALIFORNIA OA R #
MURRIETA, CA 92562
(951)677-8415
Lic. No.: 753190
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 olicy number are:
Carrier STATE FUND Policy Number 1542746-2008
_ I certify that, in the perfo nce of the work for which this permit is issued, I shall not employ any
person in any manner s to become subject to the workers' compensation laws of California,
and agree that, if I sho become subject to the workers' compensation provisions of Section
3700 of the Labor Cod shall forthwith comply with those provisions.
Dat /� /J 0 Applicant:
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.
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 ap lic tion becomes null and void if work is not commenced
within 180 days from date of issuance of uch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state th a above information is correct. I agree to comply with all
city and county, ordinances and state laws relating to Iding construction, and hereby authorize representatives
of this cou y to/inter upon the above-mentioned pro ty for inspection purposes.
Date �Y tjiSignature (Applicant or Agent):
.Application Number 09-00000876
Permit . . . ELEC-TEMPORARY POWER
Additional desc .
Permit Fee 30.00 Plan Check Fee
.00.
Issue Date . . Valuation
0
Expiration Date 2/10/10
Qty Unit Charge Per
Extension -
BASE FEE
15.00
1.00 15:0000 EA ELEC TEMPORARY POWER POLE
15.00
-----------------------------------------------------------------------------
Special Notes and Comments
TEMPORARY POWER"POLE PER APPROVED PLAN &
S.T.
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 30.00 .00 .00
30.00
Plan Check Total .00 .00 .00
.00'
Other Fee Total 1.00- .00 .00
1.00
Grand Total 31.00 .00 .00
31.00 _
LQPERMIT
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REVISIONS
MARCI.1 2000
IN TME? Cl'TYO� La OU�A
COUNTY OF RNERSIOE. TATE O CALIFORNIA
TENTAT VE TRACT
MAP O. 31202
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City of La Quint'a
Building 8T SafetyDivision
P.O. Box 1504, 78-495 Calle Tampico
Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
(� CLa
Project Address: 52-285 Silver Star Trail
Owner's Name: Desert Cheyenne, Inc.
A. P. Number:
Address: 78401 Hwy. 111 Suite G
City, ST, Zip: La Quinta, CA 92253
Legal Description:
Contractor: James 0. Harington Development, •Inc.
Address: 40960 California Oaks Rd. #283
y `.ti` mom }w'S,>i
Telephone: F;�;��;>.�::;.
P 760 777-9920 m
Project Description:
City, ST, Zip: Murrieta, CA 92562
Temporary Power
Telephone: 951 506-1123
State Lic. # : 753190
City Lic. #; 5091
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: --X-:.:. �::� � ::.,W< � :�.
w�;,::.+.:. - ,•:;>z ; ,..,.:
r:L{�n�;;:}�w:4fS:idr:•}ti:<.•i,:.•r-
. r{i�+:j J�':rt r.4r:itviiry,{{{.}ari:ii i::>i}y'i'•:i.
State Lic. #: ,g <•>
Construction Type: Occupancy:
Project type circle one New Add'n Alter Repair Dern
Name of Contact Person:
Sq. Ft'
#Stories:
#Units:
Telephone # of Contact Person:
Estimated Value of Project: $500;.00,.
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
RWd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amoun-
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
2"" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.1.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review,.ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A,I.P.P,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees