06-0152 (RER)_ , "O. BOX i564"'• , s ,VOICE (760) 777; 7012 '
- 'i,78-495 CALLE TAMPICO • `: FAX (760) 777-7011 ' `
t. LAQUINTA; CALIFORNIA 92253 r J ' ' BUILDING & SAFETY DEPARTMENT • - INSPECTIONS (760) 777-7153-
4 r ` ^ A s �s , ,' BUILDING PERMIT • .
a � •.• r.,:.' Date: , -1/11/06 •.
Application. Number: �53
0000152 Owner: -
- , Property Address: 0"AVENIDA NAVARRO MARK & JEROD LUNDQUIST
"APN. 774-095-004-21• -000000- 3330 AVENIDA NAVARRO r .
'• 'Application description: REMODEL - RESIDENTIAL _ QUINTA, CA 92253
,t Property Zoning: ;COVE RESIDENTIAL r, . Other- struct ,info_ : C *�• �•
Application valuation: ' , 1000 "' a
t e�ooV Co rac r:
Applicant:. - Architect or Engineer: ` {• ner
DITION,� 2005 ,
LICENSED CONTRACTOR'S DECLARATION - - WORKER'S COMPENSATION DECLARATION '
±I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with - r I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of. the Business and Professionals Code, and my License is in full force and effect.' ` _ 1 have and will maintain a certificate of consent to self-insure for workers' compensation, as.provided
License Class: 'License No.: 4 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is l
• ' - _ issued. _ • ' -
Date: Contractor: 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
OWNER-BUILDER DECLARATION _ insurance carrier and policy number are:_-
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier - - - - - - -.- - - - - _ - - - - - -.- - - - Policy Number
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to �' - I certify that, in the performance'of the work for which this permit is issued, I shall not employ any -
,construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, • '
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - and agree that, if I should become subject to the" i.erscompa sation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall ith co ly w' those provi ions. �S "
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for apermit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: • Z.7/17 n� Y ,, ican� t: l ,j - `t �Sr'
(A) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and • `a 4� -
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE W ' COMPEN TION COVERAGE IS UNLAWFUL, AND SHALL
• - _ Contractors' State License Law does not apply to an owner of property who builds or improves thereon, ' SUBJECT AN EMPLOYER TO CRIMI L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND -
and who does the work himself or herself through his or her own employees, provided that the `.} 'DOLLARS ($100,000). IN ADDITIO TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN _
„improvements are not intended or offered for sale. If, however, the building or improvement is sold. within ' SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). - . _ - APPLICANTACKNOWLEDGEMENT• . "
( • 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
ter., 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of `conditions and restrictions set forth on this application. „.
r property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for .
pursuant to the Contractors' State License Law.). _ _ _ • whose benefit work is performed under or, pursuant to any permit issuedasa result of this application, y '
•�.�` • (_ 1 I am exempt under Sec.- , B.0.C. for this reason • . '+ " ' - - the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and emplcyees•for any act or omission related to the work being "
performed under or following issuance of this permit. . _
Date: ry[a Owner: `# 2. t 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
`• - e l; TRUC ON LENDING AGENCY ' - - - permit to cancellation. - ---- �
I hereby affirm under penalty of perjury that re is a construction lending agency for the performance of the -_ ' •` ' I certify that I have read this application and state that the above information i orrect. I agree to'cbmply with all
' work for' which this permit is issued (Sec. 3097, Civ: C.). - + city and county ordinances and state-laws relating to building c struction, and h eby authorize representatives _
ty r' '•v - of this county to enter upon the above-mentioned propert fo ecti pure es. �^
• ± . Lender's Name.
.+: t - - - - •� ��' ' _ .- J D t7 6_?,9 Signature (Applicant or Age
• ♦ ,� ' 'Lender's Address: - - - � �) ,:• �
• '� � i •• 4 1.. L��'- _
• • LQPERMIT�- • ..• .� ` ." •• % '"r' .•' - • - ' � - _ •• `
Application Number . . . . 06-00000152
Permit BUILDING PERMIT.
Additional desc .
Permit Fee . . . . 25.00 Plan Check
Fee ..
16.25
Issue Date Valuation
1000
Expiration Date 7/10/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
5.00 2.0000 HND BLDG 501-2,000
10.00
- -----------------------------------------------------------------
Special Notes and Comments
REPLACE WINDOWS/SAME SIZE/MINIMUM
U -FACTOR OF .65 & SHGC OF .44.
----------------------------------------------------------------
Other Fees . . . . . . . ENERGY REVIEW FEE
1.63
Fee summary Charged Paid Credited
Due
---------- ----------
Permit Fee Total 25.00 .00
----------
.00
25.00
Plan Check Total 16.25 .00
.00
16.25
Other Fee Total 1.63 .00
.00.
1..63
Grand Total 42.88 .00
.00
42.88
Bin #°
City of La Quinta
Building 81: Safety Division n
P.O. Box. 1504, 78-495 Calle Tampico 2),?/? 021-
La Quinta, CA 922.53 -,(760) 777-7012
Building Permit Application and Trackin-T Sheet
Permit # j
Project Address:' �J��Ar_ b
A. P. Number:
Owner's Name: A-pl—/�--
Address:'
e- N14jAW 6
Legal Description:
City, ST, Zip: ��—�•
Contractor:
Address:
Telephone:
Project Description: 41 AJ I ./
a
V010,4/
City, ST, Zip:
Telephone:
0
-L`
State Lie. # : City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Construction Type: Occupancy: .
Projtype (circle one): • New Add'n Alter Repair Demo
S . Ft
#Stories:
# Units:
Telephone # of Contact Person:
APPLICANT: DO N94
s '�ated Value of Project: �O
ITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Recd
TRACHING
Plan Check submitted
PERMIT FEES
Item ,
Amount
Structural Calcs.
Truss Cates.
Energy Calcs.
Reviewed, ready for corrections
Called Contact Person
Plans. picked up
Plan Check Deposit
Plan Check Balance
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading. plan
2°d 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:
Planning Approval
Pub. Wks. Appr
'`" Review, ready for corrections/issue
ct Person
Called ContaEE
Date of permit issue
Developer Impact Fee
E
A.I.P.P. .
School Fees
Total Permit Fees
�'
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you -should be aware that as "Owner/Builder" you are the responsible panty of record.on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required, by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project,. and such persons are not licensed as contractors or
subcontractors, then you may be 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 income tax withholding, federal social security taxes, worker's
compensation insurance, disability. insurance costs and unemployment compensation contributions.,
There may be financial risks for you if you do not carry out these obligations, and,these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration).. For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts are all•)wed to perform their
work personally or through their own employees, without a licensed contractor or subcontrac_or, only, under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "OPner/Builder" building
permit, erroneously implying that the property owner is providing his .or her own labor and material personally.
Building permits are not required to be signed by property, owners unless they are performing their own work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State .License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA
DEPT. OF BUILDING AND SAFETY
78;495 Calle Tampico
La Quinta, CA
(760) 77-712a
FAX 0) 7 - 011
E SI /DATE
- Aj -c, zu, wA-1g-ig-vrcf Q-1—
PROPERTY ADDRESS
PERMIT NUMBER(S)
L
"WO