05-2200 (RER)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 05-00002200 Owner:
Property Address: :48 30�-C
9OACHELLA DR` M/M DAUBE
{t APN: 646-250-012-12 -4275 - 49830 COACHELLA DR
Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 45000
Contractor:
Applicant: D hitect or Engineer: BLAKESLEY., DONALD RAY
jUN 2 4 2005 49950 JEFFERSON ST, STE #130
INDIO, CA 92201
(760)342-8450
®F�QU%QI(/k Lic. No.: 839472
CITY _ _...•c nEPT-
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
SepOcrh 7000) of Division 3 of the Busin ss and Professionals Code, and my License is in full force and effect.
censeClas: B cense o.: 839472
Date: !/ C ractor: �/`'�r
•OWNER -BUILDER DECLARATFON
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
t— 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).:
(_) 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, 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
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:
LQPERA1IT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/22/05
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 EXEMPT Policy Number EXEMPT
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 the Labor Code, I shall forthwiffi coTply with those provisions.
Date {/� pplicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE S 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 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
o�fprisrcount to an er upon tove-mentioned pro 'nspection pur ses.
?/
Date: w ignature (Applicant or Agentl: /
Application Number . . . . . 05-00002200
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 382.00
Plan Check
Fee
248.30
Issue Date . . . .
Valuation
. . .
. 45000
Expiration Date 12/19/05
c Qty Unit Charge Per
Extension
BASE FEE
252.00
20.00 6.5000 THOU BLDG 25,001-50,000
----------------------------------------------------------------------------
130.00
Permit . . . ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . . 15.00
Plan Check
Fee
3.75
Issue Date . . . .
Valuation
. .
0
Expiration Date 12/19/05
Qty Unit Charge Per
Extension
BASE FEE
----------------------------------------------------------------------------
15.00
Permit . . . MECHANICAL
Additional desc .
Permit Fee . . . . 15.00
Plan Check
Fee
3.75
Issue Date . . . .
Valuation
. . .
. 0'
Expiration Date .. 12/19/05
Qty Unit Charge Per
Extension
BASE FEE
--------------------------------------------
------------------------------=-
15.00
Permit PLUMBING
Additional desc .
Permit Fee . . . . 15.00
Plan Check
Fee
3.75
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date . . 12/19/05
Qty Unit Charge Per
Extension
BASE FEE
t
15.00
---------------------------------
Notes and Comments
RESIDENTIAL REMODEL TO KITCHEN AND
BATHROOM. RELOCATE FAU UNIT TO ATTIC.
STRUCTURAL REVISION TO ADD BEAM FOR
HALL CEILING REVISION. R-3 OCCUPANCY,
TYPE V -N CONSTRUCTION, 2001 CODES.
------7--------------------------=------------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE
24.83
LQPE1011T
Application Number . . . . . 05-00002200
----------------------------------------------------------------------------
Other Fees . . .
. . . . . .
STRONG MOTION (SMI) - RES
4.50
Fee summary
Charged
----------
Paid Credited
----------
Due
-----------------
Permit Fee Total
427.00
--------------------
.00 .00
427.00
Plan Check Total
259.55
.00 .00
259.55
Other Fee Total
29.33
.00 .00
29.33
Grand Total
715.88
.00 .00
715.88
LQPERA11T
, '? CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS + el1�/pE i1�MIT NUMBER p r- ZZO 0 OWNER BUILDER -8
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's License
Workers Com ensatior Insurance.°`...
City Business License'
Y
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/xV
EARTHWORK IC -12)
CONCRETE (C-8)
FRAMING (C-5)
STRUCT. STEEL (C-51)
MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (C-35)
DRYWALL (C-9)
HVAC IC -20)
ELECTRICAL, (C-10)
.p
— U
/
�7 (j
�j
4 1rlq
%3f- 00r
ROOFING (C
SHEET METAL (C43)
FLOORING (C'=:15):.
GLAZING (C-17)'.
INSULATION. (C-2)
SEWAGE DISP. 0-42)
PAINTING (C=33)
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C-27) '.
POOL (C-53)