08-1859 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T 0
- it!t 4�wQ�w
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 oft Business and Professionals Code, and my License is in full force and effect.
Lice a Class: C2 7-053 License No.: 859417
Date: 1(121 d ontractor.
OWNER -BU ER 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, 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.).
(_) 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 ) I am exempt under Sec. , BAP.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:
-LQPERMIT--
Owner:
DUGDALE
81315 LEGENDS WAY
LA QUINTA, CA 92253
Contractor:
AMERICAN LANSCAPE/
85265 DAMASCUS AVE
COACHELLA, CA 9223
(760)880-1173
Lic. No.: 859417
S OF
Q
' WORKER'S COMPENSSAA ION DE�CLARt:7.k
I hereby affirm under penalty of perjury one of the followi g decl cratY rts.
1 have and will maintain a certificate of con^,c t to self-ins>�,rompeiisaliun, as Provided
for by Section 3700 of the Labor Code, fo the unartce 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 STATE FUND Policy Number 1890134-08
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
�� 1n 3700 of the abor de, I sl on ply with those provisions.
+gate
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CO AGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE PTO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:, 11/21/08
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is'made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances.and state laws relating in co structi hereby authorize representatives
of es unt1fy to enter upon the above-mentioned propert r i ecti n purpo as.
Date: '2 11 J$ gnature (Applicant or Agent):
Application Number:
y0.8v. 00 001' 9
Property Address:
81315 LEGENDS WY
APN:
762-420-032- - -
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
200
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 oft Business and Professionals Code, and my License is in full force and effect.
Lice a Class: C2 7-053 License No.: 859417
Date: 1(121 d ontractor.
OWNER -BU ER 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, 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.).
(_) 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 ) I am exempt under Sec. , BAP.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:
-LQPERMIT--
Owner:
DUGDALE
81315 LEGENDS WAY
LA QUINTA, CA 92253
Contractor:
AMERICAN LANSCAPE/
85265 DAMASCUS AVE
COACHELLA, CA 9223
(760)880-1173
Lic. No.: 859417
S OF
Q
' WORKER'S COMPENSSAA ION DE�CLARt:7.k
I hereby affirm under penalty of perjury one of the followi g decl cratY rts.
1 have and will maintain a certificate of con^,c t to self-ins>�,rompeiisaliun, as Provided
for by Section 3700 of the Labor Code, fo the unartce 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 STATE FUND Policy Number 1890134-08
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
�� 1n 3700 of the abor de, I sl on ply with those provisions.
+gate
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CO AGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE PTO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:, 11/21/08
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is'made, each person at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances.and state laws relating in co structi hereby authorize representatives
of es unt1fy to enter upon the above-mentioned propert r i ecti n purpo as.
Date: '2 11 J$ gnature (Applicant or Agent):
Application Number . . . . . 08-00001859
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . .
15.00
Plan Check Fee
9.75
Issue Date . . . .
Valuation . . .
. 200
Expiration Date
5/20/09
Qty Unit Charge.
Per
Extension
----------------------------------------------------------------------------
BASE FEE
15.00
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . .
17.25
Plan Check Fee
4.31
Issue Date
Valuation . . .
. 0
Expiration Date
5/20/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
3.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20
2.25
----------------------------------------------------------------------------
Special Notes and Comments
INSTALL BBQ & FIREPIT
- GAS STUB -OUTS
PREVIOUSLY INSPECTED.
Other Fees . . . . .
-
. . . ENERGY
--- ------------------------------
REVIEW FEE
.98
STRONG
MOTION (SMI) - RES
.50
Fee summary Charged
---------------------------
Paid Credited
------------------------------
Due
Permit Fee Total
32.25
.00 .00
32.25
.Plan Check Total
14.06
.00 .00
14.06
Other Fee Total
1.48
.00 .00
1.48
Grand Total
47.79
.00 .00
47.79
LQFERMIT
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,
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tie,
O LAWN AREA PAVER
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STEP UP 1 1 06 Z
PAVER 600-0
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Cal
LOGGIA
DUGDALE RESIDEN�C�E
81.315 LEGENDS WAY
LA QUINTA CA. 92253
P STACY, STONE FINISH ON:
STEPS
PILASTERS
FIREPIT EXT.
SPA EXTERIOR
EQUIP:
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POLICYHOLDER COPY
... 5K
STAT P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
COMPENSATION
=' INSURANCE
FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 11-21-2008 GROUP:
POLICY NUMBER: 1890134-2008
CERTIFICATE ID: 2
CERTIFICATE EXPIRES: 11-01-2009
11-01-2008/11-01-2009
0
CITY OF LA QUINTA SK
ATTN: BUILDING DEPARTMENT
PO BOX 1504
=!< LA QUINTA CA 92247-1504
CD
`% This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
:- California Insurance Commissioner to the employer named below. for the policy period indicated.
This policy is not subject to cancellation by'the Fund except upon 10 days advance written notice to the employer.
We will also give you 10 days advance notice should this policy be cancelled
prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded' by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
HORIZED REPRESENTATI PRESIDENT
"',...UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING:
THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER;
EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING
CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS'
COMPENSATION LAW.
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
SANCHEZ ROEL SK
85265 DAMASCUS AVE
COACHELLA CA 92236
[B14,SKj
tREV.2-051 PRINTED : 11-21-2008
Bin #
City of La Quinn
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 #
,,'V
0V
Project Address: CCC t6,� I)S W
Owner's Name: �
A. P. Number:
Address:
Legal Description:
City, ST, Zip: L_
Contractor:
Telephone:
W."".
Address: gs -26S ,4S cxv -S /c, -QE
Project Description: R S
city, ST, zip: �,A L-
Telephone:7�os--&p I% 73
e^ VIVO" - •
. {�
State Lic. # : 78S '7
City Lic. #:
Arch., Engr., Designer:
of
L7
Address:
City, ST, Zip:
z 7
.
Telephone: _. v
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'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
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsrissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN I-IOUSE:-
''" 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 Per Fees
Check a License or Home Improvement Salesperson (HIS) Registration - Contractors Stat... Page 1 of 2
Department of ConsumerAffairs
Contractors State License Board
Contractor's License Detail - License # 859417
ds DISCLAIMER: A license status check provides information taken from the CSLB license database. Before
relying on this information, you should be aware of the following limitations.
CSLB complaint disclosure is restricted by law (B&P 7124.6). If this entity is subject to public complaint disclosure, a link
for complaint disclosure will appear below. Click on the link or button to obtain complaint and/or legal action information.
Per B&P 7071 17, only construction related civil judgments reported to the CSLB are disclosed.
Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration.
Due to workload, there may be relevant information that has not yet been entered onto the Board's license database.
License Number: 859417 Extract Date: 11/13/2008
AMERICAN LANDSCAPE & POOLS OF CALIFORNIA
Business Information: 85265 DAMASCUS AVENUE
COACHELLA, CA 92236
Business Phone Number: (760) 393-3630
Entity: Sole Ownership
Issue Date: 05/24/2005
Expire Date: 05/31/2009
License Status: This license is current and active. All information below should be reviewed.
CLASS DESCRIPTION
Classifications: C27 LANDSCAPING
C53 SWIMMING POOL
CONTRACTOR'S BOND
This license filed Contractor's Bond number 100031471 in the amount of $12,500 with
the bonding company
Bonding: AMERICAN CONTRACTORS INDEMNITY COMPANY.
Effective Date: 08/28/2007
Contractor's Bonding History
This license is exempt from having workers compensation insurance; they certified that
they have no employees at this time.
Workers' Compensation:
Effective Date: 03/14/2005
Expire Date: None
Personnel listed on this license (current or disassociated) are listed on other licenses.
http://www2.cslb.ca.gov/OnlineServices/CheckLicense/LicenseDetail.asp 11/13/2008