05-4979 (RER)1�
J
11111111IIIIEIIII11111111141
P.O. BOX 1504 - -
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
05--00004-9797M
54208 AVENIDA ALVARADO
774-203-011-14 -000000-
REMODEL - RESIDENTIAL
COVE RESIDENTIAL
400
cettit ot 4 alba
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
GREG BECKER
54208 AVENIDA AL
LA QUINTA, CA 92
(310)462-3544
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor:
Owner
Date: 12/14/05
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 Business and Professionals Code, and my License 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 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 15500).:
( 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, ant 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 I am exempt under Sec. , B.&P.C. for this reason
• CONSTRUCTION LENpING 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
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 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 the Labor Code, I shall forthwith comply with those provisions.
Date: �2 +c.„ --
To Applica
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 is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize repsentatives
of this county to enter upon the above-mentioned property for inspection purposes.
Date:-12-Signature� (Applicant or A
Application Number 05-00004979
Permit
Additional desc
Permit Fee .
Issue Date . .
Expiration Date
BUILDING PERMIT
15.00
6/12/06
Qty Unit Charge Per
BASE FEE
Plan Check Fee . .
Valuation . . . .
9.75
400
Extension
15.00
Special Notes and Comments
REPLACE FRONT WINDOW WITH SMALLER
ONE/STUCCO. AROUND IT.
Other Fees - ENERGY REVIEW FEE 1.96
Fee summary Charged Paid Credited Due
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
15.00
9.75
1.96
26.71
.00
.00
.00
.00
.00
.00
.00
.00
15.00
9.75
1.96
26.71
Bin #
City of La Quinta
Building et Safety Division
Permit #
' "l
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: 5 Lr 7_0 go iv ,4_,,,, ,ick` v a4'ra4:
Owner's Name:
A. P. Number:
• Address:
Legal Description:
City, ST, Zip:
-a,\os clerde.S Q.
Contractor:
Telephone: lei_ 5 (i
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Address: •
Project Description:
City, ST, Zip:
\ y
Telephone:
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A Mek u—e,,r. oI"vf _ (X.111 A
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
•
Telephone:
Construction Type: Occupancy:
vii 4v1c90 G1,
State Lic. #:�:
, •., *.,4•'$�
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: ;hod d
Sq. Ft.: 5 d
I # Stories: 1
# Units: i
Telephone # of Contact Person: (, to .- "?. 3 — %3 fen
Estimated Value of Pro-ect:9 LA 00. o .
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item •
Amount
Structural Calcs.
•
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction •
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'" 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
fTotal Permit Fees
i` -.7
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