10-0303 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: ` 10-00000303
Property Address: 77224 CALLEPOTRERO
APN: 774-262-040-14 -000000-
Application description: RE -ROOF
Property Zoning: COVE RESIDENTIAL
Application valuation: 2000
Applicant:
T-iht °F 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Architect or Engineer:
Xf -
------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and -Professionals Code, and my License is in full force and effect.
License Class: B _ i nse No.: 431792
Dater '/0 Contractor w
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 70001 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 offeredfor 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 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:
.4 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:
HERRERA AVONNA
77224 CALLE POTRERO
LA QUINTA, CA 92253
(760)564-0593
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
D
Contractor: _ .. .ADT° V .............
TR CONSTRUCTION �{ p
77224 CALLE POTRERO r + IS 1 2 2��0 I
LA QUINTA, CA 92253
(760) 831-1863 CiY%t^Fc
Lic. No.. 431792
=v NQS••
Date: 4/09/10
—-------—------—--——---------------—-----—-----
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: .
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 b Eome subject.to the workers' compensation provisions of Section
6 3700 of the Labor Code, all forthw' 1 co ply with those provisions.
Date: 4� `'/ D pplicant:
WARNING: FAILURE TO SECURE ORKERS' 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 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 a ve information is correct. I agree to comply with all
city and county ordinarices and state laws relating to buildi onstruct* nd hereby authorize representatives
of this county to enter upon the above-mentioned pro or inspect urposes.
Date:—/O Signature (Applicant or Agent):
Application Number
. . . . 10-00000303
Permit . .
. RE -ROOF
Additional desc .
Permit Fee
30.00
Plan Check Fee
.00
Issue Date.
Valuation . .
0
Expiration Date
10/06/10
Qty Unit Charge
Per
Extension
BASE
FEE
30.00
---------------------------------------=
Special Notes and
Comments
------------------------------------
RE -ROOF PERMIT TO
2007 CODES.
-------------------------------------------
---------------------------------
__
BLDG STDS ADMIN (SB1473 )
1. 00
Fee summary
Charged
Paid Credited
Due
-----------------
Permit Fee Total
--------------------
30.00
--------------------
.00 .00
30.00
Plan Check Total
.00
.00 .00
.00
Other Fee Total
1.00
.00 .00
1.00
Grand Total
31.00
.00 .00
31.00
LQPERMIT
APR 09,2010 09:15A 000-000-00000 page 1
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0 bffi� Wfth a f wmat teewArm of at lesw OM hr.0 T MW or at tenet a 34 trtch
0 E�n9 dukfs to the attic ae healed end sealed tMhgtpoe is 6rtded b to rod deck over an atli5 or
O fn climate zones 10, 12 std 13, with .1112 d fine ventilation ares §of tatiic i Wda*m for MN 150 fu d aft task area, ant
where at M0 34 perm of the ftee > on argot vthltln 2 ke1 Vertical dretarkoe of ttw root fklpe; a
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For fSteltCB or gneStlp,flamgwdftme E1N1 w sftm tit
APR 09,2010 01:45P p 9517630769
page 1
Bin #
Qty of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 7 7 Z P0,1p, g&6
Owner's Name:
A. P. Number: 7 7y Z o4j�
Address: 7 7 ZZq (_./` -Wr P074W&
Legal Description:
City, ST, Zip: 1%Z `J' 3
Contractor:,
telephone: ?6 6,W Q ¢4 :k? :::r..: �.•:: ::;;:„ x
:,;�;;��> �ax�i?:�• y?
Address: % 7 Z Z y�4116
Project Description:
l9
City, ST, Zip:
Telephone:00 003 1
�>;<�wj<.t�:•« >nuc:;::n<:;:#:z:>s'z"<><::»::<r>
>
State Lic. # : 17*z—
City Lic. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
{: •^vcn:L.':�'I.:\:}:4�. {iw"'i'45:vy:�::iiyf."
r>:.•z%:,:�:,:;.,:;.•. tts;:;zr>
4::y�..:��`o�liyi'.•f:.::Al::.:�...�1:: �:;y..y ti:;;.;ti
r2;cfi:,;,.::c`f2i§:':•`y,C`^�C:2..,••:i:%1.%..
<•,:>; ~ ` 3 '•:<:<.<%:~:<•>
ConstructionType: Occupancy:
. .
State Lic. #:%•<''s`'
.
Project type circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories.
# Units:
Telephone # of Contact Person:
Estimated Value of Projec 2-C, 00
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
'Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Caned Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees