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08-1167 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:0= :8-O-C,O.07 116— Property Address: �555�73-P_IN, QRST APN: 775---241-`056= - - Application description: REMODEL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 10000 Applicant: Architect or Engineer: CX -------------------------------------------- LICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am li sed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the siness and Pro a ionals Code, and my License is in full force and effect. License lass: B C15 License No.: 792850 en; — (i -O5 ontractor: c&ty/ 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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. 70 31.5, 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 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 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: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/10/08 Owner: RUNYARD MICHAEL 55573 PINEHURST ` �- LA QUINTA, CA 922 Contractor: JUL D & R SELECT C S N, IN 741 EUGENE RO OF PALM SPRINGS, CA 92 Ftlmiv I.A p U11V (760)325-8231 EpT. Lic. No.: 792850 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. 0( 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 7130022527 I certify that, in the performance of thekork which this permit is issued, I shall not employ any person in any manner so as to becot to the workers' compensation laws of California, and agree that, if I ouId become sthe workers' compensation provisions of Section 3700Jlof the Labor Co I shall fortmply with those provisions. atII e: —�0— �`�Applic WARNING: FA TO SECURE WORKERS' 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 th the above info anon is correct. I agree to comply with all city and county ordinances and state laws relating to 'Iding constru on, and hereby authorize representatives of thi ounty to enter upon thea ove-mentioned grope for in o purposes. Date: "io' ��Sig re (Applicant or Agent): Application Number . . . . . 08-00001167 Permit . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 117.00 Plan Check Fee 76.05 Issue Date . . . . Valuation . . . . 10000 Expiration Date . . 1/06/09 Qty Unit Charge Per Extension BASE FEE 45.00 8.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 72.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 15.75 Plan Check Fee 3.94 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 1/06/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 .75 ---------------------------------------------------------------------------- Special Notes and Comments REPAIR FIRE DAMAGE IN BATH, MISCELLANEOUS INSULATION AND ELECTRICAL IF NEEDED ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 7.61 Fee summary, Charged --------------------------- Paid Credited ------------------------------ Due Permit Fee Total 132.75 .00 .00 132.75 Plan Check Total 79.99 .00 .00 79.99 Other Fee Total 7.61 .00 .00 7.61 Grand Total 220.35 .00 .00 220.35 LQPERMIT BIt1 # City of La Quinta Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta,.CA 922537 (760) 777-7012 Building Permit Application and Tracking Sheet Permit # `� Project Address: 5 % 3 P NG Veli Owner's Name:P' U A. P. Number: •Address: % 513 Legal Description: Contractor —DTelephone: �� B�c��¢,t� City, ST, Zip:LA Qu lZ 4 e ®� ~ Address: I �.� . Project Description: City, ST, Zip: _U 1 & Telephon :1� 32��g23 Qrn� / LU State Lic. # 9 City Lic. #: Arch., Engr., Designer: , d- QQ Address: City, ST, Zip: Telephone: Construction Type. O -1-i cupancy: State Lic. #: Project type (circle one): New Add'n AlterRepair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person:. Estimated Value of Project: I APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal r �Req'd' Rec'd TRACIUNG PERMIT 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 Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd 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:- 7rd 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