08-0511 (RER)P.O. BOX 1504 ,
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 08-00000511
Property Address: 54467 SOUTHERN HILLS
APN: 775-101-055-'- Application description: REMODEL'- RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 8000
Applicant:.
J
_ Architect or Engineer:
--------------------
r LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
. BUILDING PERMIT
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 Code, and my License is in full force and effect.
License Class: 13 License No.: 684857
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 (5500).:
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
improve for the purpose of sale.). . R
(_ 1 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.).
1 _ 1 I am exempt. under Sec. B.&P.C. 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:
LQPE%NIIT
1
Owner:
HATFIELD ARLAND/MERIS
17818 SE 57TH PL
BELLEWE WA
BELLEVUE, WA 98006
Contractor:
EDWARDS CONSTRUCTIC
51455 DESERT CLUB D
LA QUINTA, CA 92253
(760)777-8202.
Lic. No.: 684857
VOICE (760) 777-7012,
FAX (760) 777-71011
INSPECTIONS (760) 777-71534
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WORKER'S COMPENSATION DECLARATION
Date: 4/03/08
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 policy number are:
Carrier GRANITE STATE- Policy Number WC 555-61-55
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
3700o�fof the Labor Code, I shall forthwith comply with those provisions. -
Date:--dApplicant: �INL;WIUI,
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IALL
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 unde'r 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 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 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 county to enter upon the above-mentioned property ctionp es
Signature (Applicant or Agenw
Application Number 08-00000511
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . . 99.00 Plan Check
Fee
64.35
Issue Date Valuation
8000
Expiration Date 9/30/08
Qty Unit Charge Per
Extension
BASE.FEE
45.00
6.00 9.0000 THOU BLDG -2,001-25,000
-----------------------------------------------------------------------------
54.00
Permit ELECT - ADD/ALT/REM
Additional desc .
Permit Fee 26.00. Plan Check
Fee ".
6".50
Issue Date . . . . Valuation
. . .
. 0 '
Expiration Date" 9/30/08
Qty" -Unit Charge Per
Extension
BASE FEE
15.00
1.00 11.0000 EA ELEC'MISC
11:00
Special Notes and Comments
REMOVE STEPS AT FRONT DOOR AND INSIDE TO
LEVEL OUT ENTRY.
Other Fees . . . ." . . . ENERGY REVIEW FEE
6.44
Fee summary Charged Paid. Credited
Due
Permit Fee Total 125.00 .00
.00
125..00
Plan Check --Total 70.85 00
.00
70.85
-Other-Fee Total 6.44 .00.
.00
6.4.4
- Grand Total 202.29 .00
.00
.202.29
LQPEWN11T -
eft)f_ Poll aF PIVAIS
Bin #
City of La Quinta
'Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # I
' S
Project Address: sou-iUN 141`{.�s
A. P. Number: '7 75 - p l ' p 5-,5-
Legal Description: �-'f3 /-2A
Owner's Name:
Address: 5_Y—/6-7
City, ST, Zip: L/}tf j ,✓ � l (f,4 5127,5-3
k ; c3 • n..�
Telephone: �:.y.Lr.^� ,b"�%.•�<.
Project Description:
Contractor:�"�
L 7) WS n/S%.. -n(f
Address: Des•
G L4/ A
/ n
City, ST, Zip: 2zs"T
F +A 011 E PS
Telephone:, x.c :..:r ,s: r �' ^ J }
p
State Lie. # : q $,5 7 City Lie. #;
Arch., Engr., Designer: l 0 r 7-c,4 %gyp
Address:
6e L t5A_/
City., ST, Zip: /
Telephone: �(� Z g Jy�j%�`Y •`•�
�>, . •W. `4h Jf�:3�C•;�',.p.u, 7 3
State Lie. #: <f}iw?yM:
Name of Contact Person: �' d f�nl. ceA
Conshruction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:��—
Estimated Value ofProje • _• DO
APPLICANT: DO NOT WRITE BELOW THIS LINE
/:
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
8
Item Amount
Plan Check Deposit
Structural Cales.
Reviewed, ready for corrections
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Electrical
Grading plan
2" Review, ready for correctio s/issue
/. l
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
Grading
H.O.A. Approval
Plans resubmitted
IN HOUSE:-
'"' Review, ready for corrections/' ue
Developer Impact Fee
A,yP.P.
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
N;17 1
School Fees
/
Total Permit Fees 6 a ,
9 1410
P� n� N T
e Fa2� w S5 U ��- i
[ c rz � T