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06-1678 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 06-00001678 Property Address: 53430 AVENIDA CARRANZA APN: 774-081-009-16 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 50000 Applicant: Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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. LicenseClass: B -C15 46& �QLicenseNo.: 679028 Date: 6 - Contractor: c ` 6& 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, 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 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: LQPERMIT Owner: MILLER D R Contractor: PADGETT'S CLEANING/RE 535 NEW JERSEY STREET REDLANDS, CA 92373 (909)307-2769 Lic. No.: 679028 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/15/06 JUN 161006 CIN o LA QUINTA ----7 ------------- 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 AMER INS Policy Number W5734032 _ 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 37//C.Y000nof the Labor Coodde�rI shall forthwith comply with those provisions. /^ Date:y I6 _Applicant: y_` -r_ 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 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 dateof 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 property for inspection purposes. CXDate: �(fr-W� Signature (Applicant or Agent): I • --0, Application Number . . . . . 06-00001678 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 414.50 Plan Check Fee 269.43 Issue Date . . . . Valuation . . . . 50000 Expiration Date 12/12/06 Qty Unit Charge Per Extension BASE FEE 252.00 25.00 6.5000 ---------------------------------------------------------------=------------ THOU BLDG 25,001-50,000 162.50 Permit . . . ELEC-NEW RESIDENTIAL Additional desc . Permit Fee . . . 39.50 Plan Check Fee 9.88 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/12/06 Qty Unit Charge Per Extension BASE FEE 15.00 700.00 .0350 ---------------------------------------------------------------------------- ELEC NEW RES - 1 OR 2 FAMILY 24.50 Permit . . . MECHANICAL Additional desc . Permit Fee 19-.50 Plan Check Fee 4.88 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/12/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 -EA MECH VENT INST/ DUCT ALT 4.50 ---------------------------------------=------------------------------------ Special Notes and Comments. FIRE DAMAGE REPAIR PER APPROVED PLAN ---------------------------------------------------------------------------- Other Fees . . . . . . . . ENERGY REVIEW FEE 26.94 STRONG MOTION (SMI)-- RES 5.00 Fee summary Charged ---------- Paid Credited -------------------- ---------- Due ----------------- Permit Fee Total 473.50 .00 .00 473.50 Plan Check Total 284.19 .00 .00 284.19 Other Fee Total 31.94 .00 .00 31.94 Grand Total 789.63 .00 .00 789.63 LQPERn4IT 5P Permit:# City of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle.Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: 53 13 �t ��h I Q CA,r �a h2�+ Owner's Name: Qa U dl 1 2 C A. P. Number: Address: , Legal Description: City, ST, Zip: ? . Contractor: A I �S �i I edhlnA R t4 es e Telephone: ' ; .Address:- 535-New 3e(s e Project Description: /�- City, ST, Zip.K A ( S GA , "I 7i 73 .(/l A '-- a" u) �e''N Telephone: q04-W 307'27(oq 1CiJ11� , rE s`` ." die►)F ,� \ '.4 State Lie. # : io'710 Z City Lic. N w k, d- Arch., Engr., Designer: Address: S%JA City, ST, Zip: Telephone: Construction Type: uyn _:`?� Project type (circle one): New Add Alterepair Demo State Lic. #: Name of Contact Person: k&)', (�O b b Sq. Ft.: 1'%00 # Stories: # Units: Telephone # of Contact Person: ZO$-3q8I qOZ^30 %-L4Estimated Value of Project: ^006.60 Lye APPLICANT: DO OT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING . PERMIT FEES Plan Sets Plan Check submitted 1/,A& Item Amount Structural Calcs. Reviewed, ready f c rrect' // Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up j Construction Flood plain planPlans resubmitted Mechanical Grading. plan 2°" Review, ready for correctionsrssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval ' Plans resubmitted ap Grading IN HOUSE:- 7nd Review, ready for correction sue Developer Impact Fee Planning Approval Called Contact Person " s- A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees tBDi FS I� Total Permit Fees