08-1251 (RER)TdW
P.O. BOX 1504 7,
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX'(760) 777-7011
LA QUINTA, CALIFORNIA 92253+ BUILDING & SAFETY DEPARTMENT - INSPE_ CTIONS (760) 7.77-7153.
BUILDING PERMIT'
l • : Date: 8/08/08
Application Number:,,' 08-0.0001251 Owner:
Property Address: 51240 AVENIDA VALLEJO SEYED YAGHOUZI
APN:- +`.773-063-011-12 -000000 51240 AVENIDA VALLEJO O !
Application description:' .REMODEL -' RESIDENTIAL, LA QUINTA, CA 92253 1 .
Property Zoning: COVE RESIDENTIAL,. r 760)77.1-6051
Application valuation: 70000 «
C Contractor:
` .Applicant` Architect or Engineer: DESERT' HOME CONSTRUCTI
f �'A 231 E. ALESSANDRO BLVD,
RIVERSIDE, CA 92508
.. i (.951) 641-3269 C�OQG/�j D
r Lic. No:: 824985 �iOrr'9
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION .
I heieby affirm under penalty. of perjury,that I am licensed under provisions of Chapter 9 (commencing with - I hereby affirm under penalty of perjury one of the following declarations: -
Section 7000) of Division 3 of the Business and Professionals Code, and myLicense -is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B - - cense No.: 824985 for by Section 3700 of the Labor Code, far the performance of the work for'which this permit is '
.. issued._
Date:r k6Contractor:. - _ _ 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 EXEMPT ,Policy Number 'EXEMPT .,
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 workers' compensation 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 forthwith co ly ith those provisions.
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).: Date: Applicant: -
(_ 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 WAR ING: FAILURE -Tb SECURE WORKERS' COMPENSATION 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 CRIMINAL PENALTIES AND CIVILTINES UP TO ONE HUNDRED THOUSAND - - -
-- and who does the work himself or herself through his or her -own employees; provided that the _ -DOLLARS 1$100,000). IN ADDITION 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 buildor_ -
improve for the purpose, of solea 1 - - - APPLICANT ACKNOWLEDGEMENT-
(_) 1, 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
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.
property who buildsor 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 issued as result of this application,
(_ 1 I am exempt under Sec. , B.&P.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 employees for any act or omission related to the work being. _
performed under or following issuance of this permit: -
_ - Date: •'. Owner: 2. Any permit issued as_a result of this application becomes null and void if work is not commenced - -
r within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY - permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency forthe performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - + - 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 pt
Lender's Name: - � , , % _
Date: Signature (Applicant orAgent): ✓t a
Lender's Address: • - - w
LQPERMIT
- - - BASE' FEE
414.50
20.00 4.5000 THOU BLDG 50,001-100,000
90.00
Permit . . ELECT - ADD/ALT/REM,
Additional desc .
Permit Fee 76.64 Plan Check Fee ".
19.16
-Issue Date . . . . Valuation" . .
0
Expiration Date • 1/26/09
Qty Unit Charge,' Per
Extension
BASE .FEE
15.00'..
17,61.00 .0350 ELEC.NEW RES - 1 OR 2 FAMILY
61.64
Permit MECHANICAL
Additional desc
Permit Fee 37.50 Plan Check Fee
9.38
Issue Date . . Valuation
0
Expiration Date 1/26/.09
Qty Unit Charge. Per
Extension
BASE FEE
15.00
1.00 9.0000 EA.. MECH FURNACE <=100K
9:00."
1'.00' 4.5000 EA MECH VENT INST/. _DUCT-ALT.- _- _ -
-- -.4.50 - -
1.00 9.0000_EA_ MECH B/C <=3HP/TOOK BTU
9:00
Special Notes and Comments
•FIRE DAMAGE REPAIR TO EXISTING RESIDENCE
PRE-SITE INSPECTION-REQUIRED TO VERIFY
REQUIRED SCOPE OF WORK'.. 2007 CALIFORNIA
CODES SHALL BE USED TO ALL ALTERED
PORTIONS OF THE BUILDING STRUCTURE.
July 30,.20.08 11:27,:54 AM AORTEGA
Other•.Fees . . . . . .. ENERGY REVIEW FEE
32.79
LQPERMIT _
'AM1dation Number
0.8=00001251p .
Fee summary,.,
Charged,
_ . _Paid
-. Credited _. -
-: ,Due
--------- -- ----
Permit'Fee Total
--- - - - ---
618.64
---- - - - - --
.00
-- - - - - -- --
.00
618.64 '
Plan 'Check Total
356.47
.00
- .00
35.6'.47:
' Other ,Fee' Total::
32'. 79
00
00 ,
32.79'
. Gria'd.Total.,
—1007.96,
00
.00
1007.90
LQPERMIT