06-3972 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA,.CALIFORNIA 92253
Application Number:
Propj�rty Address:
APN:
Application description:
Prc-kirty Zoning:
Application valuation:
Applicant:
770-171-009-156 -000000-
ADDITION - RESIDENTIAL
LOW -DENSITY -RESIDENTIAL
4586
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
,f. � � v r ✓V
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LICENSED.CONTRACTOR'S �DECLARATION
I hereby:affirm under penalty of -perjury that I am licensedunder provisions of Chapter,9 (commencing. with -
Secti6rc70o0) of Division 3 of the Business'anC.P C e,yLicense;is-in full force and effect.
License' lass: BLi se- 487909
-,Date//177/6Contractor,,..
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 t(Ns issuance, also requires the applicant for the
permif to file. a signed 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;tie_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).:
1 _ I 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 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.).
'd 1 _ 1 1, 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.). _
( ) I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
Ihereby 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:
PETERSON DENNIS RAY
78670 AVENIDA TORRES
LA QUINTA, CA 92253
Contractor:
DESERT HABITATS'GENER
39203. 'LEOPARD STREET
PALM DESERT, CA 92211
(760)772=6062
Lic. No.: 487909
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/17/07
e o .
JAN 17 2001
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of,perjury one of thefollowing 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 foi which this permit is
issued
have and will maintain workers compensation insurance, as require -d by Section 3700 of the Labor
Code for the performanceof the work for which this permit is issued. My workers'. compensation
+ insurance carrier and policy number are:, "
Carrier ENDURANCE INS Policy Number WEN001174901
I 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 l should become ' b'e��ct'jP'he�$rkers' compensation provisions of Section
_' 3700 of the Labor Code:'I"shall fortbGitB c(o whh thd^se�roJiAIns.Ii
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,000). IN ADDITION TO 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 i come t. I agree to comply with all
city a d'county ordinances and state laws relating to building construct'. d reby ut a epos ntijyiCs
of thgou4y %tenter upon the above-mentioiLed pr2Q§1V for irlsl!ll�cti p es.
Application Number . . . . . 06-00003972
Permit . . .
ELECT - ADD/ALT/REM
Additional desc . .
'. Permit Fee . . . .
19.68 Plan Check
Fee
4.92
Issue Date . . . .
Valuation
. . . .
0
Expiration Date . .
7/15/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
y 234.00 .0200
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ELEC GARAGE OR NON-RESIDENTIAL
4.68
Permit . . .
BUILDING'PERMIT
Additional desc . .
Permit Fee . . . .
72.00 Plan Check
Fee
46.80
Issue Date . . . .
Valuation
. . . .
.4586
Expiration Date . .
1 7/15/01
Qty Unit Charge
Per
Extension
BASE FEE
45.00
3.00. 9.0000
THOU BLDG 2,001-25,000
27.00
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Special Notes and Comments
FIRE DAMAGE REPAIR TO
STORAGE AREA(234
SF) .
---------------------------------------------------7---------------------
Other Fees . . . . .
. . . . ENERGY REVIEW FEE
---
4.68
STRONG MOTION (SMI)
- RES
.50
Fee summary Charged
-----------------
Paid Credited
Due
----------
Permit Fee Total
--------------------
91.68 91.68 ..00
----------
.00
Plan Check Total
51.72 51.72
.00
.00
Other Fee Total
5.18 5.18
.00
.00
Grand Total
148.58 148..58
.00
.00
LQPERMIT