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10-0620 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tityl 4 4 Q" Application Number: "10=00000620 Property Address: 53300 AVENIDA RUBIO APN: 774-073-003-22 -000000- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 3500 6.. Appli .ant: Architect or Engineer: ---------------- LICENSED CONTRACTOR'S DECLARA BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under prov' ' n hap r 9 (commencing with Section 7000) of Division 3 of the Business and Professi Is C my se is in full force and effect. LicenseClass: CC35 n 4 Date: / --/ccontractor: ILDER DECLARATION I hereby affirm under penalty of jury that I m empt from the Contractor's State License Law for the following reason (Sec. 7031 usiness and rofessions Code: Any city or county that requires a permit to construct, alter, improve, d olish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed stat ent 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 appligant 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.). ' (_ 1 1, 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: wry, LQPEPAIIT Owner: CORTEZ JESUS & TIFFANY 53300 AVENIDA RUBIO LA QUINTA, CA 92253 ( — _—Contractor:- . . EARL'S LATH AND PLP P.O. BOX 32 DESERT HOT SPRINGS, (760)251-2467 LiC. No.: 812964 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 INGf 922J0L; 122010 CITY OF LA QUINTA FINANCE DEPT. - Date: 7/12/10 -----------------------------------'------------ 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 STATE FUND Policy Number 238006047 I certify that, in the performance of the work r which this �tssuehall not employ any person in any manner so as to beco ubject to jaws of California, and agree that, if I should beco ubject to w ers'visions of Section 3700 of the Labor Cod s forthwit m with th Date:OAjiplicant: I WARNING: FAILURE TO SWUX�/ORKE C PENSAi161Q COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYFIDDRIT IMINAL N IES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000 ION OTCOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OFT COD TEREST, 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 c with all city and county ordinances and state laws relating to building construction, a e by author eprese to eves of this county to enter upon the above-mentioned propert i pectio r S. r �� Datel��Signatute IA'ppticant or. Age�� Application Number . . . . 10-00000620 Permit BUILDING PERMIT Additional desc . . Permit Fee . . . . 63.00 Plan Check Fee 40.95 Issue Date . . . . Valuation . . . 3500 Expiration Date 1/08/11 Qty Unit Charge Per Extension BASE FEE 45.00 2.00 9.0000 THOU BLDG 2,001-25,000 18.00 ---------------------------------------------------------------------------- Special Notes and Comments RE -MODEL / PLASTER HOUSE THREE COAT - APPROVED--PER-A..-J:... ---------------------------------------------------------------------------- Other Fees . . . . . . BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 4.10 Fee summary. Charged Paid -------------------- Credited Due - ----------------- Permit Fee Total 63.00 ---------- .00 ---------- .00 63.00 P1an.Check Total 40.95 .00 .00 40.95 i Other Fee Total 5.10 .00 .00 5.10 Grand Total 109.05 .00 .00 109.05 LQPERAIIT Bin # Qty of La Qu%nta Building & Safety Dlvislon - - Permit # P.O. Box 1504, 78-495 Calle Tampico b'LD La Quinta, CA 92253 - (760) 777-7012 D Building Permit Application and Tracking Sheet Project Address:- j j�(? Owner's Name: A. P. Number: Address: 57 `C)J Legal Description: City, ST, Zip: Contractor: 01 6 Z_W; k Telephone Address: .y Project Description: City, ST, Zip:* 22d Telephone: .?xtJJ •S'Yrr•'i.4vi}..tr}'�>�! 4�. \\ v:G:v+�4u State Lic. # : City Lic. #; Arch., Engr., Designer. Address: School Fees Total Permit Fees Telephone: ?° ,�:`' ;. w . " Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo State Lic. #:�•� Name of Contact Person: I Sq. Ft.: # es: #Units: Telephone # of Contact Person: Estimated Value of Projec SOU APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMff 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 Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2W Review, ready for corrections/issue Electrical Subcontactor List I Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 'rd Review, ready for corrections/'issue Developer Impact Fee Planning Approval CalledContact Person A.I.P.P. Pub. Wks. A r PP ; Date of permit issue School Fees Total Permit Fees