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07-1670 (BLCK)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 07-00001670 Property Address: 80872 VIA PUERTA AZUL APN: 762-240-003-3 -300962- Application description: WALL/FENCE Property Zoning: MEDIUM DENSITY RES Application valuation: 224 T4ht 4 4 Q" Applicant: Architect or Engineer: Plpr LIC D CONTRACTOR'S DECll�F1�ATION 1 hereby affirm under penalty of perjury that LIC; licensed under Vrovisio of hapt� Icoi Section 7000) of Division 3 of the Busine License Class: ;?27.7, in BUILDING & SAFETY DEPARTMENT BUILDING PERMIT. ing with and effect. I r' v 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, 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 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.). (_) 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: LQPERMIT Owner: RICK HOLGUM 80872 VIA PUERTA AZUL LA QUINTA, CA 92253 Contractor: ARTISTIC LANDSCAPE INC: 78206 VARNER RD, #D PMI PALM DESERT, CA 92211 (760)360-1395 Lic. No.: 379421 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/07/07 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 tl issued. K 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. M /workers' compensation insurance carrier and policy number are: Carrier SIRIUS AMERICA Policy Number 0 CDRM11 005 6 1 certify that, in the perfo ante oft wor r whi is pVbpeR ss d, I shall not employ any person in any mann as to b pme jest to workp sation laws of California, and agree that,.�f I sh Id beco a sub' t to th orkers',y,{'�iTnodn provisions of Section t 7 3900 of the Labor�G de. I shat h ith tom with tslons. WARNING: FAILURE TO SE RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001. 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 b performed under or following issuance of this per 2. Any permit issued as a result of this application a mes null and void if w i not co ed within 180 days from date of issuance of su p rmit, or cessa ' n of w k f 180 ill subject permit to cancellation. I certify that I have read this application and state that t e ove inform do is cor ct. agr t com ly with all city and county ordinances and state laws relating to�buil ng constru ion and h eb aut riz epres ntatives of thii4aghty toAnter upon the above-mentioned pygpe for insge n utpo (Applicant or J LQPERMIT Application Number . . . . . 07-00001670 Permit . . . WALL/FENCE PERMIT Additional desc . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 224 Expiration Date 12/04/07 Qty Unit Charge Per Extension BASE FEE 15.00 ----------------------------------------------------------------------------- Special Notes and Comments 14 L.F. 4' EQUIPMENT WALL, CITY STANDARD Fee summary Charged . ----------------- Paid Credited Due -------------------- Permit Fee Total 15.00 -------------------- .00 .00 15.00 Plan Check Total .00 .00 .00 .00 Grand Total 15.00. .00 .00 15.00 05/07/2007 10:4 7605643655 FAMILYPOOLS PAGE 01/01 6v!o pno.1 -qodS glood uoil-Dnjq.suo:D win o <—' 9)715 go oql" I 7/d Inzy olj2nd . _ o pn p o- /nz� nand o!/t 0/ gog f RaN,". ria dl � Of loorr[13 lFM Amdmoi „9 �G OWN 71 7v�lhZ /r � Bin # City of La. Quinita Building ez Safety Division P.O. Box 1504; 78-49.5 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit. Application and Tracking Sheet Permit # �� Project Address:' 'Z,,. Zi,. Owner's Name: G o A. P. Number. Legal Description: Contractor./ --e_Telephoner"moi Address: 2 2 ' City, ST, Zip: } s_♦ '`a Address: 2� d( Cr --7,1/ City, ST, Zip: vvl VF `rI ] Project Description: Telephone: a Y� s. ,3x .fi 10• IN State Lic. # :C�7 -M-30. City Lic. #: 6 f Arch., Engr., Designer. Address: City, ST, Zip: Telephone:.a.,� 9 State Lic. #: t Consruction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft: # Stories: # Units: Name of Contact Person: i J't4,5 -i Telephone # of Contact Person: A4 y - - - W. Lq Estimated Yalue.of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Caics. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan V Review, ready for correctionsftue Electrical Snbcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading. IN HOUSE:- '"' Review, ready for eorrectiom-fm ae Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees