07-0379 (DSF)P.O. BOX 1504
78-495-CALLE TAMPICO
LA QUINTA, CALIFORNIA:92253
T,itit 4 " XP Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application. Number:A3
0-0.000379
Property Address:
52685 AVENIDA OBREGON
APN:
773-284-021-8 -000000-
Application description: DEMO - COMML/OTHER
Pro -pert 2onjng:
COVE RESIDENTIAL
Application valuation:
- 0
Applicant:
Architect or Engineer:
Owner:
CONTRERAS GEORGE P
52685 AVENIDA OBREGON
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor: D.
O ner
FEB ®2 2007
----------- - - - - --
FINANCE I
Date: 2/02/07
' LICENSED. CONTRACTOR'S'DECLARATION
will
I p e m e wi
- -------------------------.---—
WORKER'SCOMPENSATION 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 Piofessionals Code, and my License is In full force and effect.
I have and'will maintain a certificate'of consent to sejf-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 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:-
heretiy affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the _
Carrier Policy Number
following reason (Sec.,7031 .5, Business and Professions Code:. Any city or county that requires a permit to
I certify that, in the performance ofthe 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 as to become 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 Contractor's State
and agree that, if I.shoutd become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall forthwith comp) wiih those provisions. '
therefrom
that he or she is exempt erefrom and the basis for alleged exemption. Any violation of Section 7031.5 by
any applicant fora permit subjects the applicant to a civil penalty,of not more than five1$
hundred dollars 500).:
ate: �pL �O% scant:�
-
( 1 1, as owner.of the property, or. my employees with wages as their sole compensation, will do the work, and
10
/
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS"COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and,who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If,.however, the building or improvement is sold within
one ear of com Ietion the own r -b 'Id r he
h h b d f h h h 'd •t
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
,
t o ur en o provmg t at a or s e d� not bw d or
improve for the purpose of. sale.).
1 _ 1 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 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.).
1 _) I am exempt under Sec. B'.&P.C. 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 (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
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 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 the above information incorrect. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this my to enter upon the above-mentioned property torin"spection purpo es:
ature (Applicant or Agent): /
04,
r -.5
Application Number
. . . . . 07-00000379
Permit . . .
DEMO PERMIT
Additional desc .
Permit Fee . . . .
45.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
8/01/07
Qty Unit Charge
Per,
Extension
BASE FEE
4.5.00
--------------------------------------------------------
Special Notes and Comments
----------------------
CODE CASE - RETURN
CONVERTED GARAGE TO
.ORIGINAL CONDITION.
Fee summary
Charged Paid
Credited
Due
Permit Fee Total
45.00
.00
.00
45.00
Plan Check Total
.00
.00
.00
.00
Grand Total
45.00
.00
..00
45.00.
LQPERMIT
Bin !f
City of ' La . Qwhta
Building'u Safety Division
Permit # _
P.O Box ":1504, 78=495 Calle Tampico ..
La Quintaj,CA 92253 -.(760)'•7.77-7012
Building Permit Application'and-Tracking Sheet
Project Address:
Owner's Name:
A. P. Number:
,�
Address: /
Legal Description:
..
Crty, ST Zip:
Contractor:
Telephone: 33 z
ProjectDescnption:
Address: OvieY >
City, ST, Zip:
,
1r'
Telephone:MEN=
State Lic. # :
City Lic. #:
Arch., Engr,, Designer:
ORS C O NOo .I
Address:
City, ST, Zip:
Telephone:
ConstructronType Occupancy:
P cY:
State Lic. #:
Pr*cttype•(circle one): New Add'n Alter Repair Demo
Name of Contact Person:
T e l^ 41S
Sq. ,Ft:: # Stories: # Units:
Telephone # of ContactPerson: �/%
5 [ -3"52 2
Estimated Value:'of Project:
APPLICANT:
DO NOT.WRITE'BELOW
THIS CINE
# Submittal Req'd J.
Reed TRACIQNG . PERTVHT FEES
. Plan Sets
Plan Check submitted Item. Amount .
Structural Calci.
Reviewed, ready for correctionsPlan Check �Deposit
Truss Coles.
Called Contact Person Plsn Check Balance
Energy Calcs.
Plans picked up , Construction
Flood plain plan
Plans resubmitted Mechanical
Grading, plan
2°' Review, ready for corrections/issue • Electrical
Subcoo'tactor List .
Called Contact Person Plumbing
Grant Deed
Plans picked up S11i;I:
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-*
Review,, ready for.correctionsfissue Developer Impact Fee
Planning Approval
Called Contact PersonA.I.P.p.
Pub. Wks..Appr
Date of permit issue
School Fees
Total, Permit Fees
V'
ti •;
7
4
.3
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