08-1801 (SPIN)414
P.O. BOX 1504 QolbAIIollI VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/31/08
Application Number: 08-00001801 Owner:
Property Address: 81850 VIA SAN CLEMENTE LA QUINTA 57 ESTATES INC
APN: 764-010-008-71 -31910 - 78401 HWY 111 STE G
Application description: SPECIAL INSPECTION LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 100
Contractor:
Applicant: Architect or Engineer: HERINGTON DEVELOP INC, JAMES O
40960 CALIFORNIA OAKS RD, #283
MURRIETA, CA 92562
,^ (951)677-8415F
n (j
Lic. No.: 753190is 2?�9
J
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
1 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 y1) I, as owner of the property, am exclusivontracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Cod a Contractors' State License Law does not apply to an owner of
property who builds or improves there , and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State Lice Law.).
1 1 I am exempt under Sec. , B.&P. for this reason
ner: _
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 ISec. 3097, Civ. C.).
Lender's Name: JJ��..
Lender's Address: A"
LQPERMIT
————————————————— — — — — —— r _ ----
WORKER'S COMPENSA ION DEC�ARA�1`pf�{, r
I hereby affirm under penaltyof perjury one of the following de arations:�Iis
P 1 Y 9 �1[rl ):1 �c�-I have and will maintain a certificate of consent to s`61iHnsare•for-wocke[s' cQmp'ertsafas provid d
for by Section 3700 of the Labor Code, for the performance of the work for whic�prms s
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 oli y number are:
Carrier STATE FUND Policy Number 1542746-2007
I certify that, in the perfor a of the work for which this permit is issued, I shall not employ any
person in any manners to become subject to the workers' compensation laws of California,
and agree that, if I shout come subject to the workers' compensation provisions of Section
3700 of the Labor Code, all forthwith comply with those provisions.
Datei pplicant:
WARNING: FAILURE TO SECURE WOR ERS' 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 andmployees for any act or omission related to the work being
performed under or following issuanc f this permit.
2. Any permit issued as a result of this ap 'cation becomes null and void if work is not commenced
within 180 days from date of issuance uch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state tha a above information is correct. I agree to comply with all
city and county ordinances and state laws relating to ding construction, and hereby authorize representatives
of thi uyity to enter upon the above-mentioned prop y for inspection purposes.
`3/4tsi ure (Applicant or Agent):
Application Number
. . . . . 08-00001801
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 # 07-408 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
LQPERDIIT