RER (06-0003)P.O. BOX 1504
78-495 CALLE TAMPICO
,. LA QUINTA, CALIFORNIA 92253
Applcation Number: <� 06-00000003
Property Address: 51484 AVENIDA MENDOZA
APN:,. 773-102-005-6 -000000-
Applit"ation description: REMODEL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 4800
Tdyl-4 40"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MISURACA JACKIE
51484 AVENIDA MENDOZA
LA QUINTA, CA 92253
(760)250-3636
Contractor:
Applicant: Architect or Engineer: Owner
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 70001 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 ($500).:
(_) 1, 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 I; as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professi The, Contractors' State License Law does not apply to an owner of
property who builds or proves thereon, nd who contracts for the projects with a contractor(s) licensed
pursuant to the Co actors' State License aw.I n
(_) I am exempt under Sal. , B.&P.C. f this .son -/
;.Dater 3 a� Owner:
I hereby affirm under penaltyof rjury t
work for which this permit is is ued 1
Lender's Name:
Lender's Address:
LQPERMIT
ZZ C G
K,there is a construction lending agency for the performance of the
3097, Civ. C.).
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/03/06
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 become subject to the workers' compensation laws of California,
and agree that, if I shou b come subject to th rke s' compensation provisions of Section
37f00 of the Labor Cod shall forthwith co thos rovisions.
Date: �V 1pg icant: �C G
WARNING: FAILURE TO SEC KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO IMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. IN DITION 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 ch permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state t at a above information is correct. I agree to comply with all
city and county ordinances and state laws relatin to uildin&coii,,�n, an hereby authorize representatives
of this county toenter upon the above-mentioned p perty fpu oses.
Date: ./ �/ �ignature (Applicant o n G C��
Application Number . . . 06-00000003
{q Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 72.00 Plan Check
Fee
00
" Issue Date Valuation
. . .
. 4800
Expiration Date 7/02/06
Qty Unit Charge Per.
Extension
BASE FEE
45.00.
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE 6 WINDOWS(MIN U -FACTOR .65/SHGC
.44)/LATH PLASTER EXTERIOR OF HOUSE.
Fee summary Charged Paid. Credited
--------------------
----------
Due
---------------------------
Permit Fee Total 72.00 .00
.00
72..00
Plan Check Total .00 .00
.00
.00
Grand Total 72.00 .00
.00
72.00
LQPERMIT
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS i484 �/�i�2T�NEZ PERMIT NUMBER D63 OWNER JAcBUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are :authorized to work
on this job.. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade /Classification
Contractor.
,.,
State.:Contractor sLicense
Workeis Com ensatior Insurance
City Business License:
i
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
.Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK IC -12) .:
CONCRETE (P-8):
FRAMING :IC -5)
STRUCT: STEEL j6-51)
MASONRY (C-29)
PLUM! Q (C-36)'
LATH, PLASTER (C-35)
I X n��n-' t✓� G C (�2.
q
3 3 Z / r%
— Z3 $�
j D�
S7?4T E Alwol
DRYWALL (C-9)
HVAC (C-20)
ELECTRICAL.(C-10)
ROOFING (C-391::::':: `
'SHEET METAL (C.43)
FLOURING (C-15);
GLAZING (C-17)
f /✓til f A fl`
INSULATION: (C-2) .
SEWAGE DIS P. (6-42)
PAINTING (C=33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C=27)
POOL (C-53)