05-1189 (AR)54521 Avenida Alvarado
1111111 VIII III VIII (III 54
IE
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
05-00001189
54521 AVENIDA ALVARADO
774-272-013-1 -000000-
ADDITION - RESIDENTIAL •
COVE RESIDENTIAL
15000
Architect or Engineer:
444bti
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Qa
AUG 0 2 2005
1
CITY OF LA QUINTA
FINANCE DEPT.
J
VOICE (760) 777-7012
- FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
QUINTERO BLANCA
13036 PEPPERBUSH AVE
MORENO VALLEY, CA 92553
Other struct info C
Contractor:
Owner
DITION
2001 CBC
Date: 7/29/05
•
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 (55001.:
() 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 tor 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 ) 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 reason
r ate: /o. Owner..
CONST CTION 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
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 NO Policy Number
. p‘c 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 of the Labor Code, 1 shall forthwith comply with those provisions. .
Date: Sr / 0 • pplicant:
WAR' b G: FAILURE TO SECURE WQF:KERS' O MPENSATION 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 constructiop,and hereby authorize representatives
of this 5acii ty to enter upon the above-mentioned property for spec on purpose
Signature (Applicant or Agent):
Application Number 05-00001189
Permit
Additional desc
Permit Fee . .
Issue Date . .
Expiration Date
BUILDING PERMIT
162.00
1/25/06
Qty Unit Charge Per
Plan Check Fee . . 105.30
Valuation . . . . 15000
.BASE FEE
13.00 9.0000 THOU BLDG 2,001-25,000
Extension
•
45.00
117.00
Permit ELECT - ADD/ALT/REM
Additional desc
Permit Fee . . 19.66 Plan Check Fee 4.92
Issue Date . . Valuation 0
Expiration Date 1/25/06
Qty Unit Charge Per Extension
BASE FEE 15.00
233.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 4.66
Special Notes. and Comments
add parapets ,carports and patios.July
29, 2005 10:10:43 AM jjohnson
Other Fees ENERGY REVIEW FEE 10.53
STRONG MOTION• (SMI) - RES 1.50
Fee summary Charged Paid Credited Due
Permit. Fee Total
Plan Check Total
Other Fee Total
Grand Total
LQPERMIT
181.66
110.22
12.03
303.91
.00 .00
.00 .00
.00 .00
.00 .00
181.66
110.22
12.03
303.91