07-1786 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant: .
07-00001786
54799 RIVIERA
775-031-005- - -
REMODEL'- RESIDENTIAL
LOW DENSITY RESIDENTIAL
3200
Tuit 4 4 QuAlM
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 my License is in full force and effect.
License Class: License No.: '
Date: Contractor:
OWNER -BUILDER DECLARATION
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: Anycityor 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 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 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 1$500).:
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
thestructure 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.).
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 reast�
_ A / • a !f _
Date:
Owner:
I —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: .
CHARLES GAUTHIER
54-799 RIVIERA
LA QUINTA, CA'.92253
Other struct inf
Contractor:
Owner
DITION
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
6/19/07
WORKER'S 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.
_ 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
_ I certify that, in the tperformancelbeme
work for which this permit is issued, I shall not employ any
person in any msubject to.the workers' compensation laws of California,
and agree that, ibject to the workers' tion provisions of Section
3700 of the Labwith com those provisions.
Date.(Qd /U L -"'Applicant:
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 ($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.
'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 of 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 actor 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 n and void if work is not commenced
within 180 days from date of issuance of s h perm' , or ssation of work for 1 su ject
permit to cancellation.
I certify that I have read this application and state that ve i or i i orrect. I agree to comply with all
city and county ordinances and state laws relating to i i con n, and hereby authorize representatives
of this cco�u/7tty to enter upon the above-mentioned pro e s cti purposes. !
Date: J 1 Signature (Applicant or Agent):
Application Number
07-00001786
Permit
ELECT -,ADD/ALT/REM
Additional desc .
Permit Fee
16.50
Plan Check Fee
4.13
Issue Date . . . .
Valuation
0
Expiration Date
12/16/07
Qty Unit Charge
'Per
Extension
BASE
FEE
15.00
2.00 .75.00
----------------------------------------------
PER ELEC
DEVICE/FIXTURE IST 20
-------------------------------
1.50
Permit
MECHANICAL
Additional desc .
Permit Fee . . .
21.50
Plan Check Fee
5.38
Issue Date
Valuation . . .
. 0
Expiration.Date-.
12/16/07
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 6.5000
EA MECH
OTHER MECH EQUIPMENT
6.50
----------------------------------------_-------------
Special Notes and Comments
----------------
---_---
ADD EVAPORTATIVE COOLER
TO GARAGE
Fee summary Charged
Paid. Credited
Due
--------- ----------
Permit Fee Total
----------
38.00
---------- ----------
.00 .00
38.00
Plan Check Total
.9.51
.00 .00
9.51
Grand Total
47.51
.00 ..00,
47.51