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06-2910 (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: 06-00002910 80160 RIVIERA 762-120-014- - - REMODEL - RESIDENTIAL LOW DENSITY RESIDENTIAL 4500 Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION 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 B 'ness and Professionals Code, and my License is in full force and effect. License ctlassi ��/B LicenseZN;G84857 4 Date: 16 tJW 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 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 ($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.). ( ) 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.). ( ) I am exempt under Sec. B.&P.C. for this reason Date: Owner: 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: LQPERNfIT Owner: B. HALL 80160 RIVIERA LA QUINTA, CA 92253 Contractor: EDWARDS CONSTRUCTIC 51455 DESERT CLUB E LA QUINTA, CA 92253 (760)777-8202 Lic. No.: 684857 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/01/06 M U SEP 0 5 Zoos Ll CIN OF LA QUINTA WORKER'S COMPENSATION DECLARATION 1 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 CALIFORNIA INS Policy Number 460023330102 _ I certify that, in the performance of the work for which this permit is issued, 1 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 LaborYe, 1 II fo i com I with those rovisions. (c�m P Y //,iDate: v Y Applicant:� ✓C 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 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 Ouinta, 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 c unt ordinances and state laws relating to bui J ec nstruction and hereby authorize representatives of this co ty o enter upon the above-mentioned grope y br in'p n ur oses. L ,./ Date:? L!o Signature (Applicant or Agent): Application Number . . . . . 06-00002910 Permit . . . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 72.00 Plan Check Fee 46.80, Issue Date . . . . Valuation . . . . 4500 Expiration Date 2/28/07 Qty Unit Charge Per Extension BASE FEE 45.00 3.00 9.0000 THOU BLDG 2,001-25,000 ---------------------------------------------------------------------------- 27.00 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 18.00 Plan Check Fee 4.50 Issue Date . . . . Valuation 0 Expiration Date 2/28/07 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ------------------------------------------------------ --------------------- ---------------------------.-------------------------- Special Notes and Comments Special T -------------------- REMOVE OLD FIREPLACE AND INSTALL NEW UNIT IN DIFFERENT LOCATION. September 1, 2006 10:32:17 AM JJOHNSON --------------------------------------------------=------------------------- Other Fees . . . . . ENERGY REVIEW FEE 4.68 STRONG MOTION (SMI) - RES .50 Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 90.00 .00 .00 90.00 Plan Check Total. 51.30 .00 .00 51.30 Other Fee Total 5.18 .00 .00 5.18 Grand Total 146.48 .00 .00 146.48 LQPERAIIT 4 Bin # G City of La Quinta Building U Safety.Division . P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tra ki g Sheet Permit # '� Project Address: ( rl VIA- Owner's Name: A. P. Number: Address: Legal Description: I Contractor:` (/lQ� City, ST, Zip: � x � Telephone: �� �' NMI Wit. Address: Project Descr' qUz 3 City, ST, Zip:Lb_QLA Telephone: s7 Z 71" _ State Lic. # : City Lic. #: 2( Arch., Engr., Designer: C Address: • City, ST, Zip: Telephone: ..p s fi State Lie. #: x Name of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Aer Repair Demo Sq. Ft.: a # St(' , # Units: Telephone # of Contact Person: Estimated Valu roject: 1 APPLICANT: DO NOT WRITE.BELOW tflS- # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted V3 Item Amount Structural Calcs. Reviewed, ready for corrections q tp Plan Check Deposit Truss CRICS. Called Contact Person W Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready f correction tissue 2 Electrical Subcontactor List Called Contact Person ?,y Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted v6 Grading IN HOUSE:- ''" Review, ready for corrcctio iss) I b Developer Impact Fee Planning Approval Called Contact Person 11 A.I.P.P. Pub. Wks. Appr Date of permit issue �. School Fees Total Permit Fees p --;�/U�a