06-3033 (RR).,, -r,- ,
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO - FAX (760) 777-7011
LA QUINTA;iCALIFORNIA 92253 BUILDING & SAFETY. DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: :8/21/06
Application Number: 06-00003033 Owner:
Property Address: 51373 AVENIDA VALLEJO CARRANZA ROBERT M
APN: 773-083-019-7 000000- 51-373 AVENIDA VALLEJO
Application description: RE -ROOF 0 LA QUINTA, CA 92253 '
Property Zoning: COVE RESIDENTIAL �O - ---------------------------------
Application valuation: 2000 ti �� .
_ ail
" SV Contractor:
Applicant:. Architect or Engineer.. j 0 Owner -
----------------------.-----------
• i LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I hereby 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 my License 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: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is .
issued.
Dater .' -Contractor: _ 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 Policy Number
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit toI certifythat, 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 ers' 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'Cooshatforthwii�"m it those provisions.
h t h h m t th f -th b' f th 11 d 'A I' 1 S 7031 5 b I
t a e ors a ,s exe p ere rom an a asps or e a ege exemptiion. ny vo anon o ection . y
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (5500).:. '
1 _ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and f
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The l
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 _ I 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 contractors) licensed
pursuant to the Contractors' State License Law.).
1 _)• I'am exempt under Sec. , B.&P.C. for this reason
117
CONSTRUCTION LENDING A CY
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: .
.. Lenders Address: _ • -
WARNING: FAILURE 10 SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,0001. INADDITION 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 informatioKhery
agree to comply with all -
city and county ordinances and state laws relating to buildin on ruction, horize representatives •
of this county t0 enter upon the above-mentioned properi r in ecit n u
i
ate' -
Sign atur A p6 "ant or Agent):
Application Number 06-00003033
Permit •. . . RE -ROOF
Additional dese
_
Permit Fee 30.00
Plan'Check
Fee
.00'
Issue Date
Valuation
. . .
. 0
Expiration Date 2/17/07
Qty .Unit Charge Per
Extension
BASE
FEE
30.00
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Special Notes and.Comments
RE -ROOF SHINGLES
Fee summary Charged
Paid Credited
Due
-------------- -
Permit Fee Total 30.00.
--
•.00
.00
30.00
Plan Check Total .00
.00
.00
.00
Grand Total 30.00
.00
.00
30.00
LQPERM IT
-
Bin # -
City of La ( uinta
Building & Safety.Division .
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Per mi #
,�.�%�
Project Address:
A. P. Number:
Legal Description:
Owner's Name: ZA
Address: QeA- r
City, ST, Zip:
yy,, /
Contractor: (/��//��" / t�tPif'�
p — G zy,
Tele hone: - � 7Z
Project Description:
Address:
City, ST, Zip:
e—'
Telephone:
am MM
State Lic. # :
. City Lic. #:
Arch., Engr., Designer:
Address:'
City, ST, Zip:
Telephone:
= 41-
Construction Type:Occupancy: M�
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
## Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE. BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES ,
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
-------------
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:- _
7r4 Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks'. Appr
Date of permit issue
School Fees
Total Permit Fees
i�
•N -V