06-1444 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tihf 4 stP "
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
06=00001444 '
Property Address:
52420 AVENIDA VELASCO
APN:
773-265-009-9 -000000=
Application description:
REMODEL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1100
Applicant: Architect or Engineer:
------------------
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: License No.:
'Date: Contractor:
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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(j1 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.). -
(_ 1 1, 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
propertywho 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
Owner:�—
NSTRUCTION LENDING 65ENCY
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:
TERRI MINDELL
31-855 DATE PALM DR
LA QUINTA,'CA 92253
--------------------
Contractor:
Owner
VOICE (760) 777-7012
. FAX (760) 777-7011
INSPECTIONS (760) 777-7153-
.0/06
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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 Policy Number
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 subje to the w�Ike,' mpensation provisions of Section
3700 of the Labor Code, I shall fqr �bmply wd pr ions.
-Date: — Applicant:,_
ap
WARNING: FAILURE TO SECURE.W,�P, ERS' COMPENSATION COVERA UNLAWFUL, AND SHALL -
SUBJECT AN EMPLOYER TO CRIfjMNAL PENALTIES AND CIVIL FINES UP O 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.'
certify that I have read this application and state that the above information is c ect.- I agree to co wyZ lalll
city and county ordinances and state laws relating to building construct¢, a reby authorize rep t ves
of this county to enter upon the above-mentioned property for insp tNf purq W, �.,
VAR
Application Number . . . 06-.00001444
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee 27.00 Plan Check
Fee
17.55
Issue Date Valuation
1100
Expiration Date.. 10/07/06
Qty Unit Charge Per
'Extension
BASE FEE
15.00
S; 6.00 2.0000 HND BLDG 501-2,000
12.00
Permit . . . ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . . 22.50 Plan Check
Fee
.5.63
Issue Date Valuation
0
Expiration Date 10/0.7/06
Qty Unit Charge Per
Extension
BASE FEE
15.00. `
1.0.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
7.50
Special Notes and Comments
1 -REPLACE DRYWALL INTERIOR.2.REPLACE
EXTERIOR WOOD PANELING WITH CULTURED
STONE.3. REPLACE 7 WINDOWS WITH .58 U
FACTOR/.36.SHGC WINDOWS. REPLACE
KITCHEN & BATHROOM LIGHT FIXTURES PER
' 2005 CALIF ENERGY CODE.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . 'ENERGY REVIEW. FEE
1.76 --
Fee summary Charged Paid Credited
----------
Due
Permit Fee Total 49.50 .00
----------
.00
49.50
Plan Check Total 23.18 .00
.00
23.18
Other Fee Total 1.76 .00
.00
1:76
Grand Total 74.44 .00 -
.00
74.44- -
LQPERMIT -
.