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09-1156 (BLCK)P.O. BOX 1504 . 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 4 u�rt,�w BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777.-7153 _ Date: 11/02/09 Application Number: 09~0000-1156 Owner- • Property Address: 78705 AVENIDA TORRES BOB HULL APN: 770-172-005-162 -000000- 29501 NEIGHBORS BLVD .Application description: WALL/FENCE BLYTHE, CA 92225 Property Zoning: LOW DENSITY RESIDENTIAL -----=--------------=------------ Application valuation: 2122 ^Applicant: Architect or Engineer d"' QIP LICENSED CONTRACTORS DECLARATION I hereby affirm under penalty of perjury that) am licensed under provisions of Chapter 9 (commencing with. Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. ' License Class: License No.:. 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 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.). 1 _ 1 1, 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.). - 1 _ ) 1 am exempt under Sec. , B.&P.C. for this reason CONSTRUCTION. LENDING AGENCY I hereby affirm under penaltyof perjury that there is a construction lending agency for the performance of the work for which this permit is issued ISec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT Contractor: Owner ED, --------------------------- L �z•,. I " � � - •r�1F 1;r; .,A !dl! .. .hr. � r�� NTe� ,- — ' 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 4in�surance carrier and policy number are: "��SUC,+�� 7�%�/v G Carrier% `� SlcEXTMTR-gv�SR Number 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 kde, I shall forthwith comply with those provisions. I,�c.nWARNING: FAIL RE 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, indemnifyand 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. Icertify that I have read this application and state that the above information is correct. I agree to comply with all city and'county ordinances and state laws relating to building construction; and hereby authorize representatives of this ou y enter up the above-mentioned property\nfo\r inspec ' purposes. D �v • ignature (Applicant or Agent): �. et=4 y I LQPERMIT Application Number . . . . 09-00001156 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee 54.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 2122 Expiration Date 5/01/10 Qty Unit Charge Per Extension BASE FEE 45.00 1.00 9.0000 THOU, BLDG 2,001-25,000 9.00 ---------------------------------------------------------------------------- Special Notes and Comments REMOVE EXISTING MASONRY WALL AT FRONT OF PROPERTY AND CONSTRUCT -98 L.F. 5' GARDEN WALL, CITY STANDARD. 2007 CODES. --------------------------------7---------------------- Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited, --------------------------------------------------------- Due Permit Fee Total 54.0.0 .00 .00 54.00 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 55.00 00 .00 55.00 Bin # City of La Quinta Building 8r Safety Division ' P.O. Box 1504, 78-495 Calle Tampico O� La Quinta, CA 92253 - (760) 777-7012. Building Permit Application and Tracking Sheet Z Permit # l 1 JOR Project Address: 1-7r5 7057 ta' P* wner's Name: A. P. Number: 7 7C) — / %,7 -CC_) j Address: 7a7�- Legal Description: Contractor: City, ST, Zip: Telephone: Address: Project Description:�� City, ST, Zip: C I 4C Telephone: hone: State Lic. # : CityLic. #; f., Designerr� Q rr q--7 �-IC7t 1 / Address: City., ST, ZiP: LCI Telephone: // hone: �pT� <� Construction on TYpancy: Pe. �ecu a i. State ProJ oecttYPe �circle n e. N ewAdd'n Alter Repair De m Name of Contact Person: /�> ��v� Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: ated Value of Project: 7_4E; ,e. APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'.d TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan , Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees zs Nov 03 09 10:17a Sue Wiley 5419975163 p.2 ACOP. CERTIFICATE OF LIABILITY INSURANCE GREGA E LIMITS SHOWN MAY HAVE BEEN REDUCED B PAID CLAIMS. i1/ATE 3/2oa9 ' -PRODUCER (541) 997-5010 FAX: (591) 997-5163 Western Sierra Insurance Services , LLC License #OE75976 4715 Heceta Beach Road Florence OR 93711 THIS CERTIFICATE IS ISSUED AS A ONLY AND CONFERS NO RIGHTS HOLDER. THIS CERTIFICATE DOES ALTER THE COVERAGE AFFORDED BY MATTER OF INFORMATION UPON THE CERTIFICATE NOT AMEND: EXTEND- OR THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Hull Farms Inc. 29501 Neighbors Boulevard i Blythe CA 92225 INSURER A: Star Insurance Company INSURER B: Travelers Tins Company INSURER C: INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING AN REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VVHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS' SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. GREGA E LIMITS SHOWN MAY HAVE BEEN REDUCED B PAID CLAIMS. AOD' TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE DATE M%IiDDNY POLICY EXPIRATION DATE MMIDONYI LIMITS GENERAL LIABILITY EACr1 CCIIRRERCF $ 1OD000>0 p" I. eaocmcc $ 50000 rIB3 X COMfJEI4CU4LGENERAL LIABILITY 700 -2985L245 -TIL -08 06/10/09 06/10/10 MFD EXP !ar ono erson) $ 5000 CLNPdS MADE-ij OCCUR P -RSCN - Z ADV INJURY RY S 100000.0 ' ' GENERAL AGGREGATE $ 2000000 GEN L AGGREGATE LIPAIT APPLIES PER: PRODUCTS - COMP/OP A. G S 2000000 PQO- POLICY J CLDC AUTOMOBILE LIABILITY ' • COMBINED.S INGLE LWIT (Ea accidcn:) $ ANY AUTO ALL OWNED AUTOS BODILY INJURY' ;Perpersaal S SC-IEOULED AUTOS HIRED AUTOS BODILY INJURY „ $ ;Per accident) NON -O W.NED AUTOS PROPERTYDAMAGE S (Per accident) - GARAGE LIABIL(TY. AUTO ONLY- EA ACC DENT $ OTIiER THAN EA ACC S ANYAUTO ALTOON-Y: AGG S EXCESS/UMBRELLA LIABILITY EACH OCnURRFNC AGGREGATE Y OCCUR 17 CLAIMS MADE S DEDUCTIBLE $ RETENTION 4 VJC S'(ATU- OTIi- A WORKERS COMPENSATION AND p, [L, E.L EACH ACCIDENT $ 1 , 000 , Or]0 EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE OFFICE%TAEMBEREXCLUDED? 900050e5670WC 0452861 1/1/2009 1/1/2010 E._. DISEASE - EA EMPLOYEES 1, 000, 0•]0 E.L. DISEASE- POLICY LIMIT S 1 , 000 , D ]0 IF yes, describe order SPECIAL PROVISIONS b=lov.• iI OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSE MENTISPECIAL PROVISIONS As respects: 78705 Avenida La Torres, La Quinta, CA 92253 CERTIFICATE HOLDER CANCELLATION FOR INFORMATIONAL PURPOSES ONLY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT: BLT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Karl T Hansen I.--. _ --- - '--- --- _ -- --D ACORD CORPORATION 1988 ACORD 25 (2001108) INS025 iD:08).Bsa Paye : of 2 Nov 03 09 10:17a Sue Wiley 541"99751.63 p.3 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. 'A statement on this certificate does not confertights to the certificate holder in lieu of such 'endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificale holder, in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not. constitute a contract, between the issuing insurer(s), authorized representative or producer, and the certificate holder, ncr does it affirmatively or negatively, amend, extend or alter the coverage afforded by the policies listed thereon. Al:vttu-[b Iluulfuu) - INS025 Ioiom.oga Page 2'af 2 t T B it D t. milt o in b 1 2 u d e Su a l 0 09 g p L I v