04-4376 (DSF)MAY 18 2004 �
CITY OF LA QUINT"
FI`JAkU.QFPT.
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
Application Number . . . . . 04-00004376 Date 5/18/04
Property Address . . . . . 55915 TURNBERRY WY
APN: 767-560-005-39-000000-
Application description . . . DEMO - SINGLE FAMILY
Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL
Application valuation . . . . 0
Owner Contractor
DR STEVE FOUNTAIN DURKTON, MARK
14010 JUNE WAY 69683 PLEASANT GROVE
SARATOGA CA 95070 CATHEDRAL CITY CA 92234
(760) 578-4940
WCC: EXEMPT
WC: EXEMPT 01/09/05
CSLB: 505442 02/01/05
CCC: B
Other struct info . . . . . NUMBER OF UNITS 1.00
Permit . . . . . . DEMO PERMIT
Additional desc . .
Permit Fee . . . . 45.00 Plan Check Fee .00
Issue Date Valuation 0
Qty Unit Charge Per Extension
BASE FEE 45.00
-
Special Notes and Comments
DEMO OF EXISTING
WALLS/WINDOWS/DRYWALL/STUCCO & CONCRETE
IN PREPARATION FOR REMODEL.
Fee summary Charged
Permit Fee Total 45.00
Plan Check Total .00
Grand Total 45.00
Paid Credited Due
.00 .00 45.00
.00 .00 .00
.00 .00 45.00
P.O. Box 1504 VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: d - 1 Date: Eot'
Applicant: G0 VTri,+C;ro
Applicant's Mailing Address:
Architect or Engine r:
Jtl
Architect or Engi eer`s Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
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 Lice a is in full force and effect.
License Class_ - a , , (rl Lice a No. 5OS9
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 cf 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 doiIars ($500).)7
U 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 rmproves thereon, and who does the work
himself or herself or 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.)
U I, as owner of the property, am exclusively conlracting 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.).
U I am exempt under Sec. , BA P.C. for this reason
WORKERS' COMPENSATION DECLARATION
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:
Carrie Policy Number
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 agrD'Iould become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
�} forthwith comply with those prov'Datelt' 1 Applicant
WARNING: FAILURE TO SECURE WORKERS' POVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'$ FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of p du 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
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 Quinia, 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' of 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 time above inf rmatio s cored I agree 1 comply with all city and county ordinances and state laws relating to building
construction. and hereby authorize representatives of this coon t nt the above-mentio ed property for inspection purposes.
Date V Signature (Applicant Agent):
06/10/2004 16:44 FAX 7603637173
Jun 10 04 04:40p karen hall
06/10/2004 10:31. FA]L 7OD3637173
06/10/2004 16:16 76I33295387
BUSTER LAWRENCE GC
760 323-1600
BUSTER JAWRMC8 GC
TRISFIA 'TIFFANY
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PAGE 01
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PROPOSAL
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CALIFORNIA STATE LICENSE NUMBER: 505442 B, HIC
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69683 PLEASANT GROVE
VOICE:760.578.4940 FAX:760.328.4266
La Quinta Ca. 92264
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