DSF (07-2634)53685 Avenida Madero
07-2634
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUI NTA,, CALIFORNIA 92253
Application Number-:-- ,_
_07-00002634
Property Address:
53685 AVENIDA MADERO
APN:
774-102-021-9" -000000-
Application description:
DEMO - SINGLE FAMILY
Property Zoning:
COVE RESIDENTIAL
Applicatioh valuation:
5500
Applicant:
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 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) 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 h or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section'7031 .5 by
any plicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( ) 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.).
(_ 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
Date: -I —Z 9— Q2 Owner:
CONSTRUCTION LENDING AGENCY 10,
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: .
ESPINOZA, GUADALUPE JR
53-685 AVENIDA MADERO
LA QUINTA, CA 92253
Other,struct info .
Contractor, -
Owner
OF UNITS
-VOICE (760) 777-7012
FAX (760) 77777011
INSPECTIONS (760) 777-7153
Date: 9/28/07
OCT X10 2001
C
IY1f O LA 2L"WTA
1.00F@N{ 4r- i °=P%.
ll
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
personin 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 hall forth ith mpl ' h those provisions.
J O
Date: -/ _26—n Applicant: 7
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS U FU, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. '
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made,to the Director of Building and Safety for apermit subject to the
conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for '
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance ofthis permit.
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
permit to cancellation. -
I certify that I have read this application and state that the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned pr7py for in ectio .
Date: ` 1 _nature (Applicant or Agent):
.$,r
4 ' Application Number 07-00002634 r
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r 'Permit '. ' : _ DEMO PERMIT
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Permit Fee 45.00 Plan Check Fee
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Issue 'Date '. +• Valuation.
5500
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Expiration Date t 3/26/08 ;.. }*..
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Qty Unit Charge Per
Extension
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-'BASE FEE
45.00
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— — — — — — — _ — — —
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Special Notes and Comments '
.• ~
DEMO CARPORT AND DRIVEWAY(ASPHALT) ,.
REMOVED INSTALL. NEW CONCRETE' DRIVEWAY,.
_ AND NEW GARAGE AT LATER.'DATE PER
.CITY
REQUIREMENTS.
Fee summary Charged Paid Credited
Due
6 r".
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--
--------
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Permit Fee Total 45.00 .AO 00
45.00
o r
Plan Check Total--.. 00 00
00
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.00
• -Grand Total 45.00 .00 ':00
45:00.
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Bin #
City of
Building
P.O.. Box 1504,
La Quinta, CA 92253
Building Permit Application
La Qu.inta
Safety Division -
78-495 Calle Tampico
- (760) 777-7012
and Tracking Sheet
Permit #
Project Address: 53—W57 AVeA)4q VO
Owner's
Name: u.a S viou
A. P. Number:
Address:5
3 —Ali A d
Legal Description:
City, ST
Zip: Q CA 922 .S 3
Contractor:Owl=
Telepho
e:% 0 3C,S S
Address:
Project Description:
N^ CQ Y"
City, ST, Zip:
r '
qs121aA 14 rewt 6 Ue I
Telephone:
u.0 §1
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New C Ir ' RW&
State Lic. # :
City Lic. #:
N
W ' t l I A U ✓
Arch., Engr., Designer:
+Q r a e C i
Address:
re-
City, ST, Zip: -
Telephone:` " +a
State Lic. #:
Name of Contact Person:
Constru
tion Type: Occupancy:
Project
Sq. Ft.:
4e circle one New Add'n Alter Repair Demo
# Stories: # Units:
Telephone # of Contact Person:
Estimated
Value of Project:
APPLICANT: DO NOT WRITE BE
OW 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 Cates.
Plans picked. up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan2""
Review, ready for correctionsr
sue
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/is
ue
Developer Impact Fee
Planning.Approval.
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Dear Property Owner:
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA, 92253
TELEPHONE (760) 777-7012 FAX
OWNER/BUILDER
An application for a building permit has been submitted in your
improvements specified.
777-7011
listing yourself as the builder of the property
For your protection you should be aware that as "OwnerBuilder"'you are the responsible party of record on such a
permit. Building permits are not required to be signed by property wners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her nal e.
Contractors are required by law, to be licensed and bonded by they State of California and to have a business license
from the City or County. They are also required by law to put t leer license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various t 'ades that you plan to subcontract, you should be
aware of the following information for your benefit and protection.
If you employ.or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federo Government as an employer and you are subject
to several obligations include State and Federal income tax wi hholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you. do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Feder i}1 Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division f Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their
work personally or through their own employees, without a licensled contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be i
permit, erroneously. implying that the property owner. is prc
Building permits are not required to be signed by property
personally.
Information about licensed contractors may be obtained by c
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verifi(
these matters. The building permit will not be issued until the
Very truly yours,
tors is to secure an "Owner/Builder" building
his or her own labor and material personally.
s unless they are performing their own work
the Contractors' State License Board in your
form so that we can confirm that you are aware of
ration is returned.
CITY OF LA QUINTA
-.-- _ -- E..-,DEPT: OF--BUILDING:AND-SAFETY^'-.—..:T
78-495 Calle Tampico t.
La Quinta, CA 92253
(760) 777-7012
FAX: ( 60) 777-7011
Los
OWNER'S SIGNATU /DATE
53 -4 1beA 1
PROPERTY ADDRESS
PERMIT NUMBER(S)
r side rfi. P
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1
570
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