06-2618 (AR)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253. ,. BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/11/06
Application Number: 06x0-00:0-2-6i��.,,:7 Owner:
Property Address: 53581 VIA BELLAGIO AL HILDE
APN: 772-510-049- _ 53581 VIA BELLAGIO
Application description: ADDITION - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5818
Contractor:
Applicant: Architect or Engineer: GEMETTE CONSTRUCTION IN
1 "� Z006
74300 HIGHWAY 111 JULu
PALM DESERT, CA 92260
(760) 346-3248 CITY OF LAQUINTA
Lic. No.: 280103 FINANCE DEPT.
LICENSED CONT AO/ITOR'S DECLARATION
I hereby affirm under penaltyof perjury that I m icensed nd provisions of Chapter 9 (commencing with
P 9
Section 7000) of Division 3 of the Business nd role
al Code, and �/�License is in full force and effect. .
License Class: B icense No.: �B'0103
/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 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1. 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 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 purp6se 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:
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:
LQPERA11T
' 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 STATE FUND olicy Number @-&08398-2006
I certify that, in the performance )b,
he work for w ich t is permit is issued, I shall not employ any
person in any manner so as omesubject o th workers' compensation laws of California,
and agree that, if I should b subject to th rkers' c at on provisions of Section
3700 of the Labor Code, I s 11 forthwith comp with tho ro ions.
Date: (7L� Applican'-"tt---, Aor
WARNING: FAILURE TO SECUE WORKeNACLTIIMES
PENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINA 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. r
2. Any permit issued as a result of this application becomes null and void if work is of commenced
within 180 days from date of issuance of such persation of wor or 8days willsubjectpermit to cancellation.
I certify that I have read this application and state that the above ionis corregree to c plwith all
city and county ordinances and state laws relating to building con and hereb thorize re tativesof this county to enter upon the above-mentioned property forinurposes. A
Application Number . . . 06-00002618
Permit . . . BUILDING PERMIT
t
Additional desc .
Permit Fee . . . . 81.00 Plan Check
Fee
.52.65
Issue Date . . . . Valuation.
5818
Expiration Date 1/07/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
4.00 9.0000 THOU BLDG 2,001-25,000
---------------------------------
36.00
Permit . . . . . . ELECT = ADD/ALT/REM
Additional desc
Permit Fee . . . . 17.52 Plan Check
Fee ._
4.38
- Issue Date . . . . Valuation
. . .
. 0
Expiration Date 1/07/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
72.00 .0350 ELEC NEW RES - 1 OR 2
FAMILY
-------------------
2.52
--------------------------------------------------------
Special Notes and Comments
SUPPLEMENTAL TO PERMIT #05-4833, TO
REFLECT ADDITION WHILE UNDER
CONSTRUCTION.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE
5.27
STRONG MOTION (SMI)
- RES
.58
Fee summary Charged, Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 98.52 .00
.00
98.52
Plan Check Total 57.03. .00
.00
57.03'
Other Fee Total 5.85 .00
.00
5.85
Grand Total 161.40 .00 •.00
161.40
LQPERAUT