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08-1806 (SPIN)P.O. BOX 1504 4 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 08-00001806 Owner: Property Address: 81833 VIA SAN CLEMENTE LA QUINTA 57 ESTATES+ APN: 764-010-008-9 -31910 - 78401 HWY 111 STE Application description: SPECIAL INSPECTION LA QUINTA, CA 9225 D Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 100 Contractor: Applicant: Architect or Engineer: HERINGTON DEVEL0 INC; 40960 CALIFORNIA O`A•KS MURRIETA, CA 92562 (951)677-8415 Lic. No.: 753190 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 of the Business and Professionals Code, and my License is in full force and effect. License Class: 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 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 own -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). (_ I 1, as owner of the property, am exclus ely contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Che Contractors' State License Law does not apply to an owner of property who builds or improves th o and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State U a Law.). (_ 1 I am exempt under Sec. , BA .+for this reason CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that thelfe is a construction lending agency for the performance of the work for which this permit is issued (Sec. 30976Civ. C.). Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/31/08 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 perfor dance of the work for which this permit is issued. My workers' compensation insurance carrier and olicy number are: Carrier STATE FUND I Policy Number 1542746-2007 certify that, in the perf r ance of the work for which this permit is issued, I shall not employ any person in any manner s as to become subject to'the workers' compensation laws of California, and agree that, if I sh u become subject to the workers' compensation provisions of Section ���� 700 of the Labor C , I shall forthwith comply with those provisions. i7atef r1 y plicant: 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 issuanc of this permit. 2. Any permit issued as a result of this a plication becomes null and void if work is not commenced within 180 days from date of issuan 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 t at the above information is correct. I agree to comply with all city and county ordinances and state laws relating building construction, and hereby authorize representatives of thisXul to�enter upon the above-mentioned operty for inspection purposes. — aa' t 6) Signature (Applicant or Agen Application Number . . . . . 08-00001806 Permit . . . SPECIAL INSPECTION Additional desc . . Permit Fee . . . . 100.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 100 Expiration Date . . 4/29/09 Qty Unit Charge Per Extension BASE FEE 100.00 ---------------------------------------------------------------------------- Special Notes and Comments SPECIAL INSPECTION TO VERIFY SFD IS ABLE TO BE FINALED. FINAL ORIGINAL SFD PERMIT # 07-411 IF ABLE Fee summary Charged Paid Credited Due ----------------------------------------------- Permit Fee Total 100.00 .00 ---------- .00 100.00 Plan Check Total .00 .00 .00 .00 Grand Total 100.00 .00 .00 100.00 LQPERMIT