08-1447 (RR)y„
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO ; FAX (760) 777-7011
LA QUINTA,"CALIFORNIA 92253 "- _ _ BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 -
BUILDING PERMIT
Date: 8/20/08
Application Number: " •~ 08=00001447 J Owner: D
Property Address: .52045 AVENIDA VALLEJO BURDEN JOSEPH L
APN: 773-222-013-2 -000000- 52045 AVENIDA'VALLEJO
Application description: RE -"ROOF LA QUINTA, CA 92253 v1J
Property Zoning: COVE RESIDENTIAL A%�/�
Application valuation: 3100 - 40
0?oOg
Co Tractor. cjryoF
Applicant: Architect or Engineer: SUNQUEST BUILDERS
'INC
�C
120'S. ARROWHEAD AVENUE FOFpTTq
o`er SAN BERNARDINO,-CA 92408
(909)884-2557..
Lic. No.: 902969 `
---------_------------------------
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
1 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 of the B als Code, and qqy License ism full force and effect.. _ 1 have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C39 forbySection 3700'of the Labor Code, for the performance of the work for which this permit is
• ��77� q- issued. -
Date: 'Y/`+ -V ontractor: - _ 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 STATE FUND Policy Number 1715110-2008
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 -.mss ject 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 370 of th e,�shallhwit empf t; rovisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by '
any applicant for permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: " Da Applicant: -
(_) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structureisnot intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO 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 CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the - DOLLARS ($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 ' r SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one yearofcompletion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale:).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 builds or 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 a result of this application, -
(_ I 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
_ 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 for the performance of the I.certify that I have read this applicati a e t at the above i rmation 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 la construction, and her by authorize representatives
'
of tl county to gy,/er upon the a ve-mentioned proper 0"fewi n purposes
Lender's Name:�
Da Ft) Signature (Appl'
k-.�Y...
Lender's Address:
LQPERMIT
,. 'Applicatipn Number 08--00001447
Permit . . . RE-ROOF'.INV FEE
Additional desc
-
- Permit Fee. 60.00
Plan Check Fee..
.00
Issue Date
Valuation
p
Expiration Date 2/16/.O;9
Qty Unit Charge Per
Extension
-BASE FEE
60.00 .
-Special Notes .arid Comments --
RE-ROOF WITH_30"YR. COMP:' SHINGLES.
INVESTIGATION FEE ASSESSED PER`1997.
-UNIFORM. ADMINISTRATIVE CODE. -§304'.,5 -.FOR
WORK.BEGUN-WITHOUT',BUILDING PERMIT,
Fee summary" Charged .Paid
Credited'
Due
Permit 'Fee Total ' 60'..00',j
`00 06.
'60. 00 .
Plan Check Total 00
00. .00
00
Grand Total 60.00'
.00, :00.•
60.00 .
LQPERMIT
Bin #
City of LaQ 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
Permit
Project Address: S U2N: A 1[-eT
Owner's Name:
A. P. Number:
Address:
Legal Description:
Contractor:4 II
City, ST, Zip: (,A Q u
'SIFT (/
Telephone: �9/ 7 I -
Address: S.,[' 1x mjL ? ,4Up r
Project Description:
City, ST, Zip:
(Zoo C'AJ tc
Telephone: rd jig C S�IMM,
310.11
C JAI
State Lic. #
CityLic. #:
fT
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Pelson:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: �2Q
# Stories:
# Units: 1
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'd
TRACKING .
PERMTT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Caics.
Called Contact Person
Plan Check Balance
Energy Calcs:
Plans bicked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" 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