04-7293 (RER)4
APN: 774.;.04:4-01.674'. ,00'0.00 -
Application description REMODEL .= R_ESTDENTIAL
Property Zoning COVE.R,ESIDENT.IAL
Application valuation 2500
Owner - CO'ntraetor
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MACSEMS BILL & REBECCA GENERAL CONSTRUCTION MGMT, INC
53-085 AVENI DA . OBREGON P . O * ,BOX 116 7.5
LA QUINTA :CA 92253'.PALM,,-'.!DESERT CA 92255
:(:76'0') 779.-0.477
:WCC: STATE.FUND
`WC 2290029026 10/01/05
CS -!LB 835775 04/30/06
CCC B
Other struct info CODE IEDITInON 2,001
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Permit BUILDING 'PERMIT
Additional desc
Permit.Fee 54 00 Plan Cheek Fee .00
Issue Date Val:uati:on 2500
Expiration Date 6/.06/05
'Qty Unit -Charge Per _ Extension
BASE FEE 45.00
1:'00 9..0000 .THOU B_LDG.2;�001:r25,.0.00_,. 9.00
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Special Notes-:.and:.Comments:
ADD ANCHOR BOLTS TO EXTERIOR.WALLS.PIER.
APPROVED PLAN. v
Fee summary. Charged Paid. Credited Due
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Permit' Fee Total 5.4 0'0' .'00 .00 54.00
Plan Check.Total' .`.00 .00 .0.0 00
Grand Total 54'.;00 00 .00 54.00
.r
P.O. BOX 1504 • '��
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 4514- ? 0145 1 Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury thatfl am licensed rider provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License is in full force and effect. /2
cense Class ense No. t�3517 C
OWNER43UILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt Trom the Contractors' 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 r@quires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended 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 the purpose of sale.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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.
,1 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' a.compensation 1pwrance carrier and policy number are:
Fer 'SThTn Wrdh �IicyNumber 27.9 Do'-L-4d2to
_ I certify that, in the performance of the work
compensation laws of California, and agr a that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with th provisions.
ate IZ'�- 0plicant
WARNING: FAILURE TO SECURE WORKERS'COMPV4SATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES 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.
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
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 p on at hose 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 applican ach agrees to, and shall, defend, indemnity and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to work being performed under or following issuance of this permit.
2. Any permit issued as a result of this application becomes null anPhe
id if work is not commenced within 180 flays from date of issuance of such permit, or
cessation of work for 180 days will subject pe t to cancellation
I certify that I have read this application and state that the b e informationorrect. I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this n to enter up above-mentioned property for inspection purposes.
/,Wate i � � Sire (Applicant or Agent):