07-2260 (RR)..-
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00002260
Property Address: 51`510 AVENIDA OBREGON
APN: 773-124-001-1 -000000-
Application description: RE -ROOF
Property Zoning: COVE RESIDENTIAL
Application valuation: 3500
Applicant:
Architect or Engineer:.
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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:• - License No.:
Date: Contractor: -
.OWNER -BUILDER DECLARATION -'
.' hereby affirm under,penalty of perjury that I am exempt from the Contractor's State. License Law for the
following reason (Sec. 7.031.5, 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 lie or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5. by
any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars,($ 500).:
1 _ 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 himseli,, r 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 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 anfownerpf - -
property who builds or improves thereon, and•who contracts for.. the projects with a con6actorjsl licensed
pursuant to the Contractors' Sta License Law.). -
(_) I am exempt under Sec. =P.C. for this reason - ,
I 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JEROD WALKER
51-510 AVENIDA OBREGON
LA QUINTA, CA 92253
---------------------------------
Contractor:
Owner
-----------------------
Date: 8/07/07
n
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. -
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 Policy Number '
certify,that;'in the performance of the work for which this permit is issued, I shall not employ any
person in any ma as to become subject to the workers' compensation laws of California,
and agree that,
'if sh Id ecome sub`ect t `the workers' compensation provisions. of Section
3700 of the Lab Cod shall o •wit c th those provisions.
Date—� pl cant: - 1 T - —
WARNING: FAILURE TO SECURE W KERS'-COMPENSATION-COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (el 00,000). 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 ser forth on thisaapplicatlon.
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 ouinta, 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 th the ov informat n is correct. I agree to comply with all
city and county ordinances and state laws relating to uildin c str cti n, nd h by authorize representatives
of thD enter upon the above-mentioned pro erty f r pe do pur
�*
Dat � Signature (Applicant or Agent):�.
Application Number . . . . . 07-00002260
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Issue Date . . . .
Expiration Date.. . 2/03/08
Plan Check Fee . . .00
Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 30.00
----------------------------------------------------------------------------
Special Notes and Comments
REROOF 60 MM & RIGID.INSULATION.
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 30.00 .00 .00 30.00
Plan Check Total. .00 .00. .00 .00
Grand"Total 30.00 .00 .00 30.00
LQPERMIT
Bin #
City of La. nuinta
Building U,Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta; CA 922'53:7 (760.) 777-7012
°Building Permit APP' 116tion and.- Tracking Sheet
Permit .#
Project Address:
Owner's Name:
A. P. Number:
Address: 1
� _ r
Legal Description: �tUAJ '�> fJl, . • G •
City, ST, Zip:
Contractor:
Address: ^ S
Telephone:oval 'M
Project Description: _
`
City, ST, Zip:lbda
Telephone: _
State tic. # : ` City Lie. #;
Arch., Engr., Designer:
\ r
Address:
City, ST, Zip:
d.
Telephone:
State Lie. #:
Name of Contact Person: r
Construction Type:. Occupancy:
•; Projecutype (circle one): ' New Add'.n Alter Repair Demo .
; .Sq. FL: �
#.Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT:WRITE BELOW THIS UNE .
#
Submittal
Req'd 1
Recd
TRACIQNG
PERMIT FEES
Plan Sets
.Plan Check submitted
Item
Amount
Structural Calcs.
: Reviewed, ready for corrections
'Plan Check:Deposit
Truss Calcs.
Called ContactPerson
Plan CheckBalance
Energy Calcs..
Plans picked up
Construction
Flood plain plan
Plans resubmitted,
Mechanical
Grading plan
.2"" Review, ready for correcdons/issue•
Electrical
Subcontactor List
Called Contact Person
Plumbing .
Grant Deed
Plans picked no
S.M.I.
I1.0.A. Approval
Plans resubmitted
Grading
s
IN HOUSE:-
'rd 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 PermitFees