07-1614 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING &'. SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
07-00001614
Property Address:
52'952�AVENIDA OBREGON
APN:
773-315-016-10 -000000-
description:
REMODEL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application,valuation:
3000
Applicant: 4 Architect or Engineer:
7
LICENSED-CONTRACTOR'SDECLARATION
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 myLicense'is in full force and effect.
License Class: License No.: -
Date: Contractor:
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 (Sec. 7031.5; 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 aligned 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,6r she is exempt therefrom and the basis for the alleged exemption. Any violationcf Section 7031.5 by
a ap licant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
I; as owner of the property; or my employeeswithwages as their sole compensation, will do the work, and
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 impr6ves thereon,
.and who does the work himself or herself through his or her own employees, provided that the
improvements a're not intended or offered for sale. If; however, the building or improyement<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.). -
(_ 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 contractors) licensed
pursuant to the Contractors' State License Law.).' .
1 _ 1 I am exempt under Sec. , B.&P.C. for this reason '
Dat r�ner' t -
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
Owner:
HOFFMAN WILLIAM
52952 AVENIDA OB
LA, QUINTA, CA 92
Other struct
Contractor:
Owner
VOICE (.760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/31/07
CPN ! U�
ION
�.
F1 A%
DITION 2001/2.005
WORKER'S COMPENSATION DECLARATION'.. '
1 -hereby affirm under, penalty of perjury onebf;the followin6 declaiations
_ 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.
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
insurance carrier and policy number are:
Carrier - - - - - - - - - - - - - - - - - - =- - -- Policy Number
Cl certify that, in the performance of the work for which this permit is issued, I shall not employ any
. -person in any manner so as to become subject to the workers'. compensation laws of California,
and agree that, if I should -become subject to the workers' compensation provisions of Section
3700 of the Labor Code, I shall forthwith omplywiththose provisions.
Date:�? 51
Applicant:r_
WARNING: FAILURE TO SECURE WORKERS' COMP.ENSATI COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO'CRIMINAL PENALTIES AND CIVIL FINES UP.TO ONE HUNDRED THOUSAND
DOLLARS ($100,000): INADDITIONTO 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 . 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 is correct. I agree to comply with all
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 inspection purposes.
Date:Signature (Applicant or Agent)`
r...
t.
LQPEPA1IT
Application Number . . . . . 07-00001614
Permit BUILDING PERMIT
' Additional desc
f
Permit Fee . . . 54.00
Plan Check
Fee
35.10
Issue Date
Valuation
3000
Expiration Date 11/27/07
9
Qty- Unit Charge Per
Extension
BASE -FEE
45..00
- 1.:00 9.0000 -THOU BLDG- 2, 0.01725'1'000
9.0'0
"
Special Notes and Comments
•=" -,: • •"CHANGE "ROOFLL NE ,TO.'SANTP' FE WITH'
PARAPET. ;FRONT AND '.,PARTIAL :'S IDES.
z: - --- ---"-------------------------------=-----------------------
-------------
•Other"'Fees. ENERGY ,REVIEW FEE
...3.51 ..
= ;-Fee summary': "Charged ,..- Paid-
Credited
Due
-- ------.----- ---- ---- - ----
Permit Ree Total. 54-:06
------•-------
:�0.0`,
---
00
----
54,;. 00
-Plan Check Total 35:10. _
00:
00 ',
35': 10.
Other Fee Total Y 51
00"_.
60'.'
3`.51
Grand Tbtal
00..
:'00
92:61•
LQPEPA1IT
Bin #
City of La QuInt a
Bullding'4 Safety :Division
-P.O. Boz 1504, 78495Calle Tampico
La Quiniq; .CA k-151— (760).'777,4"012
. r..
:Building'P:ermlt ,,p 6, and Tracking Sheet
Permit #
(P (
Project Address: C3� Z
Owner's Name:.
A. P. Number:
Address: Z'
Legal Description:.City;
ST; Zip: ; �7
W
" g
Telephone. _ a"
Contractor: ` .QI/ .
Address:
Project Description:
City, ST, Zip:
Telephone:
State Lic. # : CityLic: #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:r
_
`Construction,Type: Occupancy:
: P Y
State Lic. #:`
Project type (cir'cle one):. New Add'n. Alter Repair Demo
Sq Ft: ~ # St r"" # Units:
Name of Contact.Person:
Telephone # of Contact Person: :.
Estimated Value of Proje : - ' a
APPLICANT.:. DO NOT WRITE'BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING .
a PERMIT FEES
2
Plan Sets
Tlan.Check submitted
(C7..,
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact ` on /
Plan Check Balance
Energy Calcs.
Plans picked up I /
Construction
Flood plain plan.
Plans resubmitted
V✓
Mechanical
Grading, plan
2"d Review, ready for correcti issue
3
Electrical
Subcontactor List
a
Called Contact Person,
3
Plumbing
Grant Deed
Plans picked up
/
S.M.I.
H.O.A. Approval .
Plans resubmitted
SGrading
IN HOUSE:-
3W 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
2 r^ '-i --
IG'' �i; j` !! '1.i.1:.j
Total Permit Fees
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CaAe Coiutia .. i
ote on Plans: "All construction shall comply with the 2001 California Building, Plumbing, Mechanical,
004Electrical, and 2005 Energy Codes and all other local codes and ordinances." Remove notes
referencing other Codes.
Note on Plans: "Roof assembly shall have a class "A" fire rating." (LQMC §.8.02.080)
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