07-2620 (RER)P.O. BOX 1504
'78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 077--00-002-62"0"'��
Property Address: 51510 AVENIDA OBREGON
APN: 773-124-001-1-000000-
Appli6ation description: REMODEL -.RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 2500
BUILDING &. SAFETY DEPARTMENT.
BUILDING PERMIT
Owner:
JEROD WALKER
51510 AVENIDA OBREGON
PEQUOT LAKES, MN 64�
(922)000-0053
Contractor:
Applicant: Architect or Engineer: Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153:
SSP 28 2007.
OF LA- nteusr��J
Date: 9/28/07
LICENSED CONTRACTOR'S DECLARATION,
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty. of perjury that I am licensed under. provisions of'Chapter 8 (commencing with
I hereby affirm under penalty of perjury one'of the-fotlowirig declarations:
Section 7000)of Division 3 of the Business and Professionals Code, and my License is in full force and effect._
I haveandwill maintain a certificate of consent to self -insure for workers' compensation, asprovided
License Class: License No.::
for by Section.3700. of:the Labor Code, for the performance of the work for which this permit is
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
insurance carrier and policy number are:
hereby affirm under penalty of perjury that I am exempt from the Contracior'i State License Law for the
.,..,
Carrier 2001 CBC Policy Number - - - - - - - - - - - - - - ---
. following reason (Sec. 7031 .5, Business and Professions�Code:.Apy city,or county that requires a permit to
I certify that, in the performan f the work for which this permit is issued, I shall not employ any
construct, alter, improve,' demolish, or repair any structure, prior to its issuance; also requires the applicant for the
person in any manner so a to come subject to the workers' compensation laws of California,
permit to file -a._signed statement that -he or she is:licensed pursuant to the provisions of. the, Contracfor's' State
and agree that, if1 should ' co a bje t to a workerst'compensation provisions of Section' '
'license Law•(Chapter9 (commencing with Section 7000). of Division 3 ofthe Business and Professions Code) or
700of the Labor Code, I, all • wit om th se provisions. .
..
that he or she is exempt therefrorn.and the basis for the alleged exemption. Any violation'of Section 7031.5 by
., '
. a�nYy eppticant for a'permit subjects the•appticantto a civil penalty of not more than five hundred dollars ($500)::
•- J:.
(O'er I, as owner of the property, or imy employees with wages as -their sole compensation will.do the work, and
-t -
f��-``' the structure is not intended or offered forrsale (Sec. 7044, Business and Piofessions Code: The
WARNING: FAIL RE TO SECURE WORKERS' JMPENSATION COVERAGE IS UNLAWFUL; ANDSF,IALL
Contractors' State License Law does not apply to an owner of property whobulds or.improvesthereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENA IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
• - and who does the work himself or herselfthrough his or,her own employee s,.provided that' he
DOLLARS (5100,000),' IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED -FOR IN
improvements are not intended'or offered for sale. If, howeverythe building:orimprovement is sold within
SECTION 37,06 OF THE LABOR CODE, INTEREST, AND ATTORNEY'SFEES.
one year of completion, the owner -builder will have the burdeu'of-provingthat he or she did not build or
_.improve;for.the purpose of sale.). _ .. -. ,�„• ' . ;,.�
.,APPLICANT ACKNOWLEDGEMENT
1 —) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to.the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts -for the projects with a contractorls) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' Stat License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
. (_) I am exempt u et- Sec. P.C.or!N reason
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
ate: caner:
/,
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that th re is a construction lending agency for the performance of the
I certify that I have read this application and state that [ bove information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.).
city and county ordinances and state laws relating to bu di co ructio an r authorize representatives
Name:
of this*nlyce upon the abo- e -mentioned prope y f ecti noseLender's
�ig
re (Applicant or Agent):
Lender's Address:
r • b t .
LQPERMIT
Application Number . . . . . 07-00002620
Permit
. . . ELECT - ADD/ALT/REM
Additional
desc . .
Permit Fee
15.75 Plan Check
Fee
3.94
Issue Date
. . . . Valuation
. . .
. 0
Expiration
Date 3/26/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00
---------------------------------------
.7500 PER ELEC DEVICE/FIXTURE 1ST
-------------------------------------
20
.75
Permit
. . . BUILDING PERMIT
Additional
desc . .
Permit Fee
. . . . 45.00 Plan Check
Fee
29.25
Issue Date
. . . . Valuation
. . .
. 1937
Expiration
Date 3/26/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
15.00
-------------------------------------------------
2.0000'HND BLDG 501-2,000
-----------------------------
30.00
Permit
. . .. PLUMBING
Additional
desc .
Permit Fee
. . . . 18.00 Plan Check
Fee
4.50
Issue Date
Valuation
0
Expiration
Date 3/26/08
Qty Unit Charge .Per
Extension
BASE FEE
15.00
1.00
----------------------------------------------------------------------------
3.0000 EA PLB WATER INST/ALT/REP
3.00
Permit
. . . WALL/FENCE PERMIT
Additional
desc .
Permit Fee
. . . . 17.00 Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 563
Expiration
Date 3/26/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00
2.0000 HND BLDG 501-2,000
2.00
----------------------------------------------------------------------------
Special Notes and Comments
26 L.F. 5'
GARDEN WALL, CITY STANDARD &
BBQ ISLAND
WITH ICE MAKER AND ICE BOX.
----------------------------------------------------------------------------
Other Fees
. . . . . . . . . ENERGY REVIEW FEE
2.93
LQPERAIIT
Application Number . . . . . 07-00002620
Fee summary
Charged
----------
Paid
Credited
--------------------
Due
'
-----------------
Permit Fee Total
----------
95.75
.00
.00
95.75
Plan Check Total
37.69
.00
.00
37.69
Other Fee Total
2.93
.00
.00
2.93
Grand Total
136.37
.00
.00
136.37
LQPERAI IT
Building
Address
Owner
mailing
Address
ress 4
41a.a
PO, BOX'.! 5o4, APPLICATION ONLY
*495 CALLE TAMPICO :
jOINTA,',CALIFORNIA..'92253 •
BUILDING: TYPE -CONST. OCC. GRP.
A.P. Number
Legal Description'
Project Description
-.4
C S
City
Zip
Tel.
/_
�C
Sq. Ft.
Size,
No. No. Dw.
Stories Units
State Lic.
& Classif.
City
Lic. #
Arch., Engr.,
Designer
New ❑ lAdd ❑ Alter ❑. Repair ❑ Demolition ❑
Address Tel.
City
Zip
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
hereby affirm that I am licensed under provisions of. Chapter9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force 'and ,
effect.
r
SIGNATURE .DATE -
OWNER -BUILDER DECLARATION
I hereby affirm that I ani exempt from, the Contractor's. License Law. for the following'67
reason: (Sec. 7031.5, Business and Professions Code: Any city or county which.requires a .
Estimated ValUltlOn
PERMIT
AMOUNT
permit to construct, alter, improve, demolish, or repair anystructuie; prior.to'its issuance also
requires the applicant for such permit to lile:a signed statement. that he is licensed pursuant to ,
the provisions of the Contractor's. License Law, Chapter 9 (commencing with Section 7000) of "
Division 3 of the Business andProfessions Code, or that he is:ezempt therefrom, and the basis
for the alleged exemption. Any violation of Sectiom7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).-
Plan Chk. Dep.
Plan •Chk. Bal: .
❑'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 Profes-
Const:
sions Code: The Contractor's License Law does not apply to;an owner of property who'builds ,
or improves thereon and who does such work himself or through -his own employees, provided
that such improvements are not intended or offered for sale. If, however, the' building or; im-
provement is sold within one year of completion, the owner -builder will have the burden of
proving that he did not build or. improve for the purpose of:sale).
❑ I, as owner of the property; am exclusively contracting with licensed contractors to construct
the project. (Sec. 7044, Business and Professions Code: The;Contradtor's License Law.does'
not apply to an owner of property who builds or improves thereon, and who for'such
projects with a contractor(s) licensed pursuant to the Contractor's'.
❑ I am exempt under Sec. B. & P.C. f Y:this reason
MBCh.
`Electrical
Plumbin
g '
- S. M. 1.
Grading
-Driveway Enc.
Date owner -Infrastructure
WORKER' COMPENSATION DECLARATION
e
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's
Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
„
Policy No. Company
❑ Copy is filed with the city. ❑ Certified copy is hereby_furnished.
CERTIFICATE OF EXEMPTION FROM. .
WORKERS' COMPENSATION INSURANCE
TOTAL '
REMARKS
(This section need not be completed if the permit is for one hundred dollars:($100) valuation '
or less).
certify that in the performance of thework'for which this, permit is issued, I shall not
employ any person in any manner so as to become subject to Workers' Compensation Laws of
California.
Date Owner
NOTICE TO APPLICANT.. If, alter making'this Certificate. of Exemption you should become
subject to the Workers' -Compensation Provisions of the:Labor. Code, you must forthwith
comply with such provisions or this permit shall be deemed' revoked:
ZONE:
Minimum Setback.Distances:
, BY:
CONSTRUCTION•LENDING AGENCY
Front Setback from Center Line
I hereby affirm that there is a construction lending agency for tKe performance of the work
for which this permit is issued. (Sec. 3097, Civil Code.)
Rear Setback from RProp. Line
ear
Lender's Name
`Side Street Setback from Center Line
Lender's Address
This is a building permit when properly filled out, signed and validated, ana is subject to
-expiration if work thereunder is suspended for 180 days.
Side Setback4rom Property Line
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to'building a.
construction, and hereby authorize representatives of this'city to enter the above-mentioned
property for inspection purposes.
FINAL DATE
Issued by:
INSPECTOR
Date Permit
Signature of applicant Date
Mailing Address
Validated by:
Validation:
City, State, Zip
WHITE = BUILDING DEPARTMENT YELLOW
= APPLICANT
PINK = FINANCE
q37
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been'submitted'in your nameaisting yourself.as�the builder of the property
improvements specified.
For your protection you should be aware - that as'"Owner/Builder" you are the responsible party of record on such a
permit. Building.permits'arenot requiredao beFsigned by property: owners unless they areppersonally performing their
formed' by someone ;other than yourself; .you may protect yourself from possible
own work.'If your work is :being per
liability if that person applies for'the°proper;permii in his `6r:,. name.'
Contractors are required{by law to,be licensed a'nd bonded by'the Staie of California and, to have a business license
from the City or County- They are.. also .required by 1 1 to put their"aicense number o6 all permits for which they
apply.
• E
If you plan to do your own work ? with,. the 'exception of various trades that you plan. to subcontract, you should be
aware of the following information,for your:benefitand':protection. f
>. "?
If you employ or otherwise engage.any.persons, other than. your immediate family„and the work (including materials
and other costs) is $200.00 or, iriore' for :the entire', project, 'and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and.Federal Government as an employer and you are subject
to several obligations include State, and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs'and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department oi-Benefit Payments and the Division', of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their. own employees;".without.4 licensed ontractor or'subcoptractor, only under limited
conditions.
A frequent practice of unlicensed-p"ersons professing.to be contractors is..to.secure.an "Owner/Builder" building
permit, erroneously implying'that the property owner is providing hisaor he.r„own labor and material personally.
Building permits are not -re qu Yred to be' signed' by propery ownerIs',uniess they are 'performing their own work
personally.
Information about licensed contractors may;•be obtained,by.xontacting the Contractors' State License Board in your
community or at 1020 N. Street,;Sa¢rameiiio, California
i.
Please complete and return. the enclosed, owner buadei verification form so that;we can confirm that you are aware of
these matters. The building'permit'willinot be issued' the-veiificauon°is returned: 3
Very truly yours,
CITY OF LA QUINTA '
DEPT. OF BUILDING AND SAFETY,
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012
FAX ( 0) 777-7011
OVINE 'S SIGNATURE/DATE
a
PROPERTY ADDRESS
ev—
PERMIT NUMBER(S)'
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51510 AVENIDA05RE ; C70N Ulm UDX
LA GUINTA, CALIFORNIA. q2259