07-1774 (RER)P.O. BOX 1504
78-495 CALL TAMPICO
LA OUINTA, CALIFORNIA 92253
4- 4.'a'o AS
mi
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
LQPERNIIT .
Date: 6/19/07
Application Number: 07-0000177.4
Owner:
Property Address: 52717 AVENIDA OBREGON
GAMMINO PATRICIA A
APN: 773-284-024-11 -000000-
Application description: REMODEL - RESIDENTIAL
52-717 AVENIDA OB
LA QUINTA, `CA 92'S
Property Zoning: COVE RESIDENTIALApplication
valuation: 1000Contractor:
t77
'91007
Applicant: Architect or Engineer:
-WEST COAST. FINIS /e�/� y'
CI � Y OF LA QUIN A ' 3
_
,.:
.2104 -FRONTAGE RO. `—FINANCEDEPT.`..,x
$ACTON SEA, CA.9
(760)'394=4674.
Lic. No:: 879857
LICENSED,CONTRACTOR'S:DECLARATION;''
WORKER'S COMPENSATION DECLARATION
-
-. • ' I her affirm under penally ofp'erjury thaL51,_am Ircens d under provisions of Chapter'9. (commencing :"with
I hereby affirm under. penalty of perjury one of the following declarations
y ,
Section:•70001•of Division 3 of the Business and Professionals Code, and my.'License is in full forceiarid effect.
I`heve and.will maintain a certificate of consent to self -insure for workers' compensation, as provided
. ,
.. License;Class+ C6= -c�:""_'•-`icense No.: '87985.7
,. �`'-for by,Section 3700.of the Labor, Code, for the performance of the work for which this permit is -
_
. & _
r �
�'
9 �
issued. t}.
I have -and maintain by 3700 the Labor
Date: .C�ontractor:' i �
/
—. will workers' compensation insurance, as required Section of
Code, for the performance of the`work for.,which this permit is issued:. My. workers' compensation
-OWNER-BUILDEkDECLARATION
insuiance carrier and policy number' are:
I hereby affirm. under penalty of perjury that l am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy.Number 1828558-2006
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued,') 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 should 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 hall for ith com I with RLprovisions
that he or she isexempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
"tea
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dol4rs ($500).:
_
Date �pplicant: _ _ -
(_) 1, as owner of the property; or my employees•with.wages as theirsole compensation, will do the work, and
the structure isnot intended or offered for sale (Sec. 7044, Business and Professions Code; -The .
WARNING: FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL i
Contractors' State License Law does not apply to an owner of, property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and'who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($.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 orrimproven erit•is soul within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one-year of completion,.the owner -builder will have the burden of proving that he or she did not build or
- "' -•
'improve forthe purpose ofYsale.). _
APPLICANT ACKNOWLEDGEMENT
(_) 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 forthon this application.
property who builds or.improves thereon, and Who contracts for the projects with a'contractor(s) licensed
1 . Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant toanypermit issue&as a result of this application,
(_ 1 I am exempt under Sec. , B.&P.C. for this 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
performed under or following issuance of this permit.
Date: Owner:
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 there is a construction lending agency for the performance of the
I'certify that I have read this application and state that the above 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 building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for 'nspec ' ur oses. -
Lender's Name:
-- — _
Date:.6-,�-Signatures-(Applicant or Agentle/
Lender's Address:
LQPERNIIT .
Application Number . . . . . 07-00001774
Permit . .
. BUILDING PERMIT
Additional desc .
Permit Fee . . .
. 25:00
Plan Check
Fee
16.25
Issue Date . . .
.
Valuation
. . .
. 1000
Expiration Date
12/16/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
5.00 2.0000 HND BLDG 501-2,00.0
10.00
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Special Notes and
Comments
REPLACE 7 WINDOWS
------------------------------------------------------------------=---------
Other Fees . . .
. . . . . . ENERGY
REVIEW FEE
1.63
Fee summary
Charged 'Paid
Credited
Due
Permit Fee,Total
25.00
.00
.00
25.00
Plan Check Total
16.25
.00
.00
16.25
Other Fee Total
1:63
.00
.00
1.63
Grand Total
4'2.88
.00
.00
42.88
LQPERMIT