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07-0730 (SPIN)P.O. BOX 1504 78-495 CALLE TAMPICO LA QU.INTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application valuation: Applicant: r 0-7- 0� 0000-�0Z1 54105 AVENIDA RAMIREZ . 774-211-017-5 --0,00000- SPECIAL INSPECTION COVE RESIDENTIAL 0 Architect or. Engineer: -------------- LICENSED CONTRACTOR'S DECLARATION 414 Qamm VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 3/09/07 Owner: . VALDEZ MARIA ELENA 5.4105 AVENIDA RAMIREZ LA QUINTA, CA 92253 -- ----=----.----------------ate--- I hereby affirm under penalty of perjury that I am licensed under' provisions of Chapter 9 fcommencing4with Section,7000) of Division_3 of the Business and Professionals`Code„and my. License is in full force and;ef_fect. License Class: License No.:. Data: Contractor: OWNER -BUILDER DECLARATIOW, I hereby, -affirm under, penalty. of perjury that I am exempt from°the Contractor's State -License Law for the .:fallowing reason (Sec: 703.1 .5,-�Business and Professions Code:' Any, city or, county that requires a -permit to - C6&trUct, alter, improve„demolish; or.repaii ar y structure, prior to its issuance, also requires the applicant for the - ' permit to fiie a signed statement that he or she is licensed, pursuantto the proyisions bf 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 sheds 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 ($560).: _ ( 1- 1, as owner, of the, property, or m'y employees' With wages a; their sole compensation,_ will do the:work,'and .• the structure is,notintended or offered for sale'(Sec..7044)16usiness and Professions Code. 'The Contractors' State License tawdoesnot apply to an owner of property who builds or improves -thereon, and who does the'work himself or herself throughhis or. her own employees, provided that the iniprovements`are'not imended or offered for sale. If,- however,.the building or improvement is sold within one year of completion, the owner -builder will. have theburden of provingahathe or she did not build or improve for the'purpose of sale.): (_) I, as ownerof the.property,.am exclusively contracting with licensed.contractors to construct the project.(Sec. 7044, Business and -Professions Code:. The Contractors' State ,License,Caw"does not apply to an owner of property. v do bfuilds, 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 ,�te: V / /6wner CONSTRUCTION LENDING AGENCY 110 '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 Contractor: VI-F"•IH� Q J ..; 2001. Owner I N WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one. of. the followirig`.declarations: 1 have;and_will maintain a certificate of consent to self -insure for'wo"Wers' compensation,_ as provided forby,Section 3700 of the taborCode, for the performance ottti"ork for which this.permitis . .. .y. 'issued: - - _ I have and will maintain workeis'�compensation insurance, as required;bg 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" i. -.rte Policy Number ' ertify that, in the performance of the work'for which this permit is issued, I shall not employ,any person any manner so as'.to become'sublect 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 Lor Code I shall,forihwith /comply with those. pro visions. e: - _D pplicant:` WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS.UNLA. FUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO`ONE HUNbRED THOUSAND DOLLARS Is 100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS'PROVIDED FOR IN SECTION 3706 OF"THE LABOWCODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT Application: is hereby made,to theDirector,of Building and_Safety.fora permit subject to the 'conditions and restrictionssetforth 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 permitissued 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 omissionrelated 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 construction, and hereby authorize representatives of tnty to enter upon the above-mentioned property for inspection pur ores. vte:his — /G —10 Si ture (Applicant or Agent): A Application Number . . . . 07-00000730 Permit . . . SPECIAL INSPECTION Additional desc . . Permit Fee . . . . 100.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 9/05/07 Qty Unit Charge Per . Extension BASE FEE 100.00 ------------------------------------- -------------------------------------- Special Notes and Comments SPECIAL INSPECTION TO ASSESS PARTIAL GARAGE CONVERSION/ADD DOOR BETWEEN AG GARAGE & HOUSE. Fee summary Charged Paid Credited Due --------------------------- Permit Fee Total ---------- 100.00 ---------- .00 ---------- .00 100.00 Plan Check Total .00 .00 .00 .00 Grand Total 100.00 .00 .00 100.00 LQPERMIT Bin # City of La Quinta Building BL.Safety Division Petmit # P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and'Tracking.Sheet Project Address: - A P. Number. Owner's Name: r Q C' Z a . Legal Description:. Address: ��—.CQ 1 rQZ ST, Zip: ,�—. ' p! h 153 Contractor.. —City, , O ,Telephone � Address: �j�t Description: City, ST, Zip: Telephone: C I Q L O State Lie. #': City Lica Arch., Engr., Designer ' Address: City; ST, Zip: Telephone: State Lie.*Occupancy:Construction Type: Opancy: Name of Contact Person: � jet type (Orcle ono):. New Add'n Alter Repair Demo Telephone # of Contact Person: Sq. Fts ' . # Stories: # Units: Estimated Value of Project APPLICANT: DO NOT WRiTE,BELOW THIS UNE # Submittal Req'd •. Reed TItACICIfiC Plan Sets • PLR Check submitted PERMIT FEES Stractaral Cales. Reviewed,' ready for eorreetious Item Amount . Truss Cities. Plan Cheek Depos[t Called Contact Penton . Energy Cales. Plans picked.ap PlattCheck Balance Flood plain plan Plain resubmitted Construction Grading. plia' 2'' Review, ready for correction/ issue Mechanical SubcontacLi tor tt . . Called Contact Person Electrical Grant Deed Plans picked up Plumbing . 11:0.A. Approval Plans resubmitted . S.M:L IN HOUSE:-' r'' Review, ready for. correctioneissue Grading Planning Approval Called .Contact Person Developer Impact Fee Pub. Wks. Appr .Date of permit issue A.LP.P. School Fees ' Total Permit Fees 63/66/2607 93 03/46/2007 03/06/11 man OEM - LL 303/06 2001, Lai 03/06/2007 jo, 03/06/2007