12-0766 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING
Application Number: X12'=00000_7.6..6"'
Property Address:, 54066 AVENIDA VELASCO
APN: 774 -215 -005 -5 -000000 -
Application description: REMODEL-- RESIDENTIAL
Property Zoning:' COVE RESIDENTIAL
Application valuation: 1000
Applicant: Architect or Engineer:
- alP
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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 ago Professionals Code, and my License is in full force and effect.
License Cla s: .5 C10 License No • 909599
/ate: corrector:
lll/ OWNER-BUILDE 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).:
(_ 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-builderwill 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.).
(=) I am exempt under Sec. , BAP.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
PERMIT
Date: 8/07/12
Owner:,
RAND, SYLVIA O
54066 AVENIDA VELASCO
LA QUINTA, CA 92253
_tea a®1.
Contractor:
UNDER CONSTRUCTION' '`
15500 BUBBLING WELLS OAD 37 2012
DESERT'HOT SPRINGS'
(760) 972-7721 LA QUINTA
Lic. No.: 909599 FINAWII= nvoir
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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 foiwhich 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 become subject to the workers' compensation provisions of Section
3700 of the labor C hall forthwith comp with those provisions.
t U ppticant: -
WARNING: FAILURE TO SECUR OR KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,0001. 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 above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
ofth%lp co my to enter upon the above-mentioned property IA inspection purposes.
Daftte. S' nature (Applicant or Agent):
Application Number . . . 12-00000766
Permit BUILDING PERMIT
Additional desc..
- Permit Fee 25.00 Plan Check Fee
16.05
Issue Date Valuation . . .
. '1000
Expiration Date 2/03/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
5.00 2.0000.HND BLDG 501-21000
10.00
--------------------------- -----------------------------
Special Notes and Comments
ADD 16" HGT PARAPET'WALL TO EXISTING
ROOF. ROOF TOP HVAC EQUIPMENT.SHALL BE
SCREENED FROM VIEW PER"LQMC §9.60.140.B.
2010 CBC:
-------------------------------.-------
Other Fees . . . BLDG STDS ADMIN (SB1473)
1:00
ENERGY REVIEW FEE
1.61
Fee summary, Charged Paid Credited
Due
Permit Fee Total- '25.00 .00 .00
25.00
Plan.Check Total 16.05 .00 .00
16.05
Other Fee -Total 2.61 .00 .00,
2.61
Grand Total 43.66 .00 .00
43.66
LQPERMIT
tttn �
City of La Quints
Building 8T Safety Division
Permit #l I P.O. Box 1504, 78-495 Calle Tampico
L La Quinta, CA 92253 - (760) 777-7012
Z Building Permit Application and Tracking Sheet
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Arch., Engr., Designer:
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imated Value of Project: �a
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Telephone # of Contact Person: (�7477
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APPLICANT: DO NOT WRITI
# Submittal Req'd Rec'd
TRACKI
Grading
Plan Sets 3
Plan Check submitted
Structural Calcs.
Reviewed, ready for correctio
Truss Calcs.
Called Contact Person
Title 24 Calcs.
Plans picked up
Total Permit Fe,
Flood plain plan
Plans resubmitted
Grading plan
2nd Review, ready for correctii
Subcontactor List
Called Contact Person
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
IN HOUSE:-
"Review, ready for correctioi
Planning Approval
Called Contact Person
Pub. Wks. Appr _
Date of permit issue
School Fees
:lephone: / .1
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oject Description:
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Occupancy:
ject type (circle one): New Add'n Alter Repair Demo
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# Stories: # Units:
imated Value of Project: �a
: BELOW THIS LINE
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PERMIT FEES
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tem Amount
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Plan Check Deposit
Plan Check Balance
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Plumbing
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Developer Impact Fee
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Total Permit Fe,
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