07-2299 (RER)P.G: BOX 1504
78-495 CALLE TAMPICO
LA QUINTA; CALIFORNIA 92253
Application Number:
Applicant:
07-00002299
Property Address:
5-15l� VE"N.I.DA—OBT REEGOND.
APN:
773 -124 -001 -1 -000000 -
Application description:
REMODEL - RESIDENTIAL "
Property Zoning:
COVE RESIDENTIAL
Application valuation:
2500-
500'
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WALKER JEROD
51510 AVENDA OBREGON
LA',QUINTA, CA 92253
(760)777-1440
Contractor:
Owner
IN
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760)777-7153
Date: 8/13/07
LI -A u
AOG 7A 2007 .� .
CITY OF LA QUIPaTA
-LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby" affirm.under•penalty of: perjury that I am licensed under provisions'of'Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division:3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure, for workers' compensation, as provided
License Class: License No.:
for by Section 3700 of the Labor Code, for the performance of the work for which thispermitis
issued.
Date:. Contractor: " _ 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
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 ISec. 7031.5, Business and Professions Code: Any city or county thatrequires a permit to
construct, alter, improve, demolish, or repair any structure, prior,to its.issuarice„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 exempitherefrom 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
. Contract or;'-Sta46,ceise Caw does not apply to an owner of property who'buildscr improvesthereon,
and whodoes' the work himself or herselPthrough his or her own employees;. provided that the
:improvements are norintended 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 thepurpose of sale.).
1, as:ownerrof,.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
propeity.who builds or improves thereon, and who contracts for the, projects with a contractor(s) licensed
pursuant. io.the Contractors' State License Law.). - -
(_) I am exempt under Sec.P.C. for this reasgn -
Q 22 •1 \ •i 1�t/,
.Date 17 Ow� rQ '
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:
Lender's Address:
I,QPERA11T
insurance carrier and policy number are: ”
Carrier - - - - - - - - - - - - - - - -.- _ - - - -- 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 mann o as to become subject; the workers' compensation laws of California,
and agree that; if I ho Id• :ec -e s 'ect-to th workers' compensation provisiohs of Section
3700 of the Labor od shal orth _p with those provisions.
Date a Applicant:
- : '
WARNING: FAILURE TO SECURE WO KERSCOMPENSATIONCOVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL'ANALTIES: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.
pplication.•1. Each person upon whose behalf this application is made, each person at whoserequest'and for
whose benefit work is performed under or pursuant to any permit issued as a result of, this application,
the owner, andthe 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 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 that a above information is correct. I agree to comply with all
city and county ordinances and state laws relating to i in constr tti n, a herb uthorize representatives
fljjof this co nter upon the above-mentioned prop f inspe io PurPo
Date:. Sig
nat.�rerlApplicant or Agenq:—'
Application Number . . . . . 07-00002299
Permit . . . . . . ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . . 24.00 Plan Check
Fee
6.00
Issue Date Valuation
. . . .
0
Expiration Date 2/09/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
12.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
----------------------------------------------------------------------------
9.00
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . . 25.50 Plan Check
Fee
6.38
Issue Date . . . . Valuation
. . . .
0
Expiration Date . . 2/09/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 7.5000 EA PLB.WATER HEATER/VENT
7.50
1.00 3.0000 EA PLB FIXTURE DRAIN/VENT
-
REP/ALT
3.00
------------------------------------------------------
Special Notes and Comments
--------
-------------
220 CIRCUIT TO GARAGE & OVEN.110
CIRCUIT TO.TUB RELOCATE SWITCHES &
OUTLETS AT MASTERBATH,2ND CIRCUIT TO 3
CIELING FANSMOVE TOILET.TANKED MWH TO
TANKLESS
Fee summary Charged Paid Credited
-----------------
Due
------------------------------
Permit Fee Total 49.50 .00
----------
.00
49.50
Plan Check Total 12.38 .00
.00
12.38
Grand Total 61.88 .00
.00
61.88
LQPERA1IT
Bin #
City of La Q Uinta
Building tat Safety Division
Box -1504, 78-495 Calle Tampico
uinta, CA 92253 - (760) 777-7012 e
P*O,
. Building ermit'Application and Tracking Sheet
Permit.#
v v
Project Address:'
1
Owner's Name:
A. P. Number:
`
Address:Al
Legal Description:
City; ST, Zip:
Contractor:
Address:
;TFlephone:
maii
'Project Description:
City; ST, Zip:
(�
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Telephone:
State l:.ic. # : CityLic. #:
Arch., Engr., Designer:
Address:
A'v 44✓
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type:. Occupan :
` oject type (circle one): New Add' Alter Re air Demo.
Sg. Ft : tories:- # Units:
Telephone # of Contact Person: r ..
Estimated Value of Project:
APPLICANT:,:DO NOt. WRITE.BELOW THIS, LINE .
#
Submittal .
Req'd ..
Read
TRACIQNG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections .'
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs..
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading.plan
2°" Review, ready for correctionsfissue
Elettrical
ir�-gve
Subcontactor List
Called Contact Person
Plumbing-
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'�" Review, ready for correctionsfissue
DevelopecImpact Fee
Planning Approval
"Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date'of permit issue
School Fees
Total Permit Fees