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08-1888 (RER)P.O. BOX 1504. 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Ta�/ 4 4 Q" 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 (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 1 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 ds exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a¢y pplicant for a pe rmit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.: :( 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.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason, 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: HURWITZ,, 54-605 AN' LA QUINT (760) 7774- Contrac Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 CA 9225" \Y�At 61.. ------------------ WORKER'S.COMPENSATION DECLARATION Date: 11/24/08 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 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-thelabprSQde, I shall forthwigi 46mply with these provisions. WARNING: FAILURE TO SECUIIE WORKERS' COMPENSATION COVERA EIS UN FUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 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 Ouinta, 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. Icertify that 1 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 pr y for inspecifn purposgs. Da r re (Applicant olAgentl Application Number: 08-0'000188'8 Property Address: 5460'5 AVENIDA RAMIREZ APN: 774-275-017-5 -000000_- Application description: REMODEL - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 350 Ta�/ 4 4 Q" 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 (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 1 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 ds exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by a¢y pplicant for a pe rmit subjects the applicant to a civil penalty of not more than five hundred dollars IS5001.: :( 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.). (_ 1 I am exempt under Sec. , B.&P.C. for this reason, 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: HURWITZ,, 54-605 AN' LA QUINT (760) 7774- Contrac Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 CA 9225" \Y�At 61.. ------------------ WORKER'S.COMPENSATION DECLARATION Date: 11/24/08 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 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-thelabprSQde, I shall forthwigi 46mply with these provisions. WARNING: FAILURE TO SECUIIE WORKERS' COMPENSATION COVERA EIS UN FUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP 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 Ouinta, 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. Icertify that 1 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 pr y for inspecifn purposgs. Da r re (Applicant olAgentl Application Number . . . . . 08-00001888 Permit . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 15.00 Plan Check Fee 9.75 Issue Date . . . . Valuation . . . . 350 Expiration Date 5/23/09 Qty Unit Charge Per Extension . BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments REMOVE SLIDING GLASS DOOR AND REPLACE WITH 5' DOUBLE FRENCH DOORS. PER AJ ---------------------------------------------------------------------------- Other Fees . . . . . . . . ENERGY REVIEW FEE .98 Fee summary Charged Paid ------------------------------------- Credited ---------- Due Permit Fee Total 15.00 .00 ---------- .00 15.00 Plan Check Total 9.75 .00 .00 9.75 Other Fee Total .98 .00 .00 .98 Grand Total 2'5.73 .00 .00 25.73 LQPERMIT OWNE"VILPER INFORMATION Dear Property Owner: An application for a building,p&rnit has. been submitted in your nam e -listing. yourself -'as the builder of the property improvements specified. For your protection you, should �beawarik that as,"Owner/Buildet",syqu are the 'r6so6whble party of record on such a permit. Building permitsrequired to ,be s! gne'.d.by,p'ioi�ry'�wner'� 'hl6siieyare pe rsohally performing their own work. If youf work"is'6eing, performedDy SOneOre other than _your§elfj:you may: protect yourself from possible liability' if that person applies, for the proper pern it in his< or her name. Contractors are required by, law to, be licensed. and 66nded by the State -of. California and to, have. a business license from the City or County. They are also required -,by, I number;on all permits for which they 4w to,.pptitheir license apply. If you plan to do your'owh,,w6rk, with. the exception of;various trA&s'thAt'you plan to subcontract, you should be .; aware of the following informationfor.'yokir beriefii!ind:p`rofection. If you employ or otherwise, engage any persons other than your immediate family, and the work (including materials and 'other costs) is $20000' or -more for the ,entire ' project, and Such persons are not licensed as contractors or 01, subcontractors, then you maybe an employer: If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations include, State and Federal' mc6'ine", ta x Nvi't"h'hdld'in'g,-federal* social security taxes, worker's compensation insurance, Asability*insurance costs ,and "unemployment compensation contributions. There maybe financial risks for youif you do not carry ouf.,'these obligations,. and these 'risks are especially serious with respect to worker's compensation insurance.,-,",., f t For more specific information about your. obligations`ufidei: Federal Law xontact the Internal Revenue Service (and, if you wish, the U.S. Small -.,Bus i'nle'ss'Adftiin'istrafiOA)."-�., i1mc,irt:sgeciric ' ifif6rniation about,your obligations under State of Benjeiht'Payr�i�ts ah�� 6, Division t' 'ride s. Law, contact the D6 Oariment`�­ ndus'ri I' If the.structure is iriterided.for Sale', pr-operty owners whoire not licensed,-cohtractors. are allowed to perform their work personally or through' their own e'm`ployees,'wiiii6uf a licensed contractor - r or . subcontractor, only under limited conditions. A frequent practice of-iiiilit:ens.ed,pers6ns"professitig',to,be*,tbiitractors,ig.-to secure/ an "Owner/Builder" building owner is. his oiher own -labor And material personally. permit; erroneously,"implyi6'j`that the property, providing. oyl Building permits aretnot'required 40 be signed,by: property , owriersunless they are performing their own work ppersonally, T Information about licens'dd"c6i , itractors; may be obtai i tied by.. contacting1he Contractors' State License Board in your ommunity or At 1020 N. 5treeit, act ifo r .c S, - affieritoi.Cal nia 0814. Please complete and return the enclosed owner-buildei verification form so that we carr confirm that you are aware of these matters. The building.permit will not be issued until the verification is returned. Very truly yours, I CITY OF LA QUINTA DEPT. OF BUILDING AND. SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 ?11(760) 777-7011 -,I- OWNER'S SIGNATURE/DATE , PROPERTY PERMIT NUMBER(S) Bin # City of La Quinta ` 'Buildmg:Bl Safety. Division P:O. Box 1504, 78495,Calle Tampico La Quinta, CA 92253 (760) 77777012 -Building Permit Application and Tracking Sheet Permit # Q ;, \� "� �. er sName: A. P. Number: Addres� _ e—Z_ Legal Description: - City, ST, Zip: t Contractor:�? f Teleph--rte one: ,,,+ ,.3 x Address: ' Pro, Description: e City, ST, Zip: Telephone: ^" _ State Lie. # : City Lie. #: Arch., Engr., Designer: . Address: City, ST, Zip: Telephone: Constriction Type: Occupancy: State Lie. #: Projecttype (circle.one): New Add'n Alter Repair Demo Name of Contact Person: ✓Sq. Ft.. #Stories: T# Units: Telephone # of Contact Person: Esti--- of ProjFE ' o� APPLICANT: .0'140T WRITE; BEIQW THIS LINE # Submittal Req'd Recd : 'TRACKING PERMU FEES Plan Sets Plan Check•sub.mitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called-Contact Person . Plan Check Balance Energy Calcs. Plans picked up '_ Construction Floodplain plan Plans resubmitted Mechanical Grading plan 2"4 Review, ready.for correctionstiissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed HI>Plans Plans picked up. S:M.I. H.O.A. Approval resubmitted Grading IN HOUSE:- ''' Review, ready-Cor corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees