12-1453 (RER)4 P.O. BOX 1504 /----`ti VOICE (760) 777-7012 -.
78-495 CALLE TAMPICO C --- _-- (' FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
1 BUILDING PERMIT
Date: 12/19/12
Application Number: L�12 00001453 Owner:
Property Address: i.._77370--CALLE SINALOA CURT PARKINSON
APN: 773-122-010-7 -000000- 77370 CALLE.SINALOA
Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL.
Application valuation: 350
Contractor:
Applicant: Architect or Engineer: Owner
11
--------------------------------------------------
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
ivy for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
I 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 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.). _
I—) I am exempt under Sec. B.&P.C. for this reason
ate: 1 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: WA
LQPERMIT
----------------- - - - -- ---
WORKER'S COMPENSATIOMDECL'ARAT.ION`A�'
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' compensation7 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
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 Code, I shall forthwith comply with those provisions.
te: plicant:
WARNING: FAILURE 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 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
of this county to enter upon the above-mentioned property for inspection purposes.
Date: 2 ature (Applicant or Agent):
Application Number . . . . . 121-00001453
Permit BUILDING PERMIT INV FEE
Additional desc .
Permit Fee . . . . 30.00 Plan Check Fee
9.75
Issue Date . . . . Valuation . . .
. 350
Expiration Date 6/17/13
Qty Unit Charge _Per
Extension
BASE FEE
30.00
Special Notes and Comments
REPLACE 2 WINDOWS AND 2 FRENCH DOORS.
2010 CODES. INVESTIGATION FEE ASSESSED
PER 1997 UNIFORM ADMINISTRATIVE CODE
§304.5 FOR WORK BEGUN WITHOUT BUILDING
PERMIT.
----------------------------------------------------- ----------------------
Other.Feds BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
.98
-Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 30.00 .00 .00
30.00
Plan Check Total 9.75 1.00 .00
9.75
Other Fee Total 1.98 .00 .00
1.98
Grand Total 41.73 .00 .00
41.73
LQPERA1IT _
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LA Q IF F.1 A' CALIEFORNiek'922474504
78-495 ALLE TAMPICO"
LA QUIN A,CALIFORNiA 92253
BUiLD(Nd & SAFETY DEPARTMENT
(760) 777-7012
FAX (760) 777-70-11
Y 0- W_ UEME'S3 PACKAGE
rnsdolures &. FormLlor Owner-,
!�Oders. App, for Construction Permits
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Wilder if I sell the' property for v cb this permit is issued, I tray be bell liable for any
coed by.any subsect►tcnt owner(s) that result from any latent construction defects in the
more information regarding my obligations as, an "employee" from die In t. Rovenue
usiness Administration, the California Department of Seuefit PaYmenta, and the California
also understand I may contact the California Contractors' State Ucew Board (C�3.) at I-
xoLgov for more [information about licensed contractors.
to an Owner -Builder building permit applied for in my name, and understand that 1. am the
msponsible for proposed construction .activity at the• following address:
By and fmaucially responsible for this proposed construction activity, l will abide by all
govem Owner -Builders as well as employers.
of this form immediately of any additions; deletions, or c RoOft to MY Of the infOmn-4ion I
*d contractors areregulated by laws designed to protect the public. If Tans comet WU
LZ.,. elm r"::'vazcc.t�M' Stato uiccase Board May be 1MAIC w =g�:t `flu any fins* .M low
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