12-0078 (RER)-y, r1'.
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92.253
Application Number:'
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
12-00000078
52180 AVENIDA VALLEJO
773-223-009-14 -000000-
REMODEL - RESIDENTIAL
COVE RESIDENTIAL
191
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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: C6 License No 896973
Date: %j Contrac r. '
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 ISec. 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).:
• - (_ I 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 soldwit.....
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, 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.).
(_ 1 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
Owner:
POVEDA,.CLAUDE & LANA
74140 EL PASEO 4
PALM DESERT, CA 92260
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/26/12
Contractor: 11
OLD SCHOOL INSTAL N A_ f
9781 LUTHERAN WAY;
SANTEE, CA 92071
(619)448-6610 . J�
J 2 • 2012
Lic.-No.: 896973 -- '
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
_ I 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 for which this permit is issued. My workers' compensation
insurance carrier and policy number are: -
Carrier STATE FUND Policy Number 0011690-2011
_ 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 sho ome subject to the workers' ompensation provisions of Section' ,
u' 3700 of the Labor de, I sh II fo with comply with a pr isio s.
Date: Applicant:
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 3706OFTHE 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 authorizer esentatives
of this county to enter upon the above-mentioned pr rt or m p>f�n purposes .
Date: __& ..... Signature (Applicant or Agen
Application.Number . . . . . 12-00000078
------ Structure Information (1) WINDOW CHANGE OUT
-----
'Other struct info . . . . .' CODE' EDITION
2010
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee 15.00 Plan Check Fee
9.75
Issue Date" Valuation
191
Expiration Date 7/24/12
Qty Unit Charge Per.
Extension
BASE FEE
15.00
Special Notes and Comments
(1)'WINDOW CHANGE OUT AT.KITCHEN.-
REPLACEMENT ONLY [2008 ENERGY] 2010
CALIFORNIA BUILDING CODES.
January 26,.2012 1:54:5'6 PM AORTEGA
-_--
-------------------------------- -
Other Fees BLDG.S.TDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
.98
Fee summary Charged Paid Credited
Due
Permit Fee Total 15.00 .00 .00
15.00
Plan Check Total 9.75' .00 .00
9.75
-Other Fee Total 1.98 .00 .00
1.98
Grand .Total 26.73 ..00 ..00
26.73
LQPERMIT - -
- - -
`' �O
i� : � �� i
Bln.#
City of La Quipta
Bullding 8r Safety Dfvislon
-P.O. Box 1504,78-4 95 Calle Tampico
14.Qllinta, CA 92253.:(760) 777-7012.
Building Permit Application and Tracking Sheet
Permit #
�• °°1
Project Address: -- I O `/tN . VAZJrjo Owner's Name:. L •�1 c4-, L6
A P. Number. Address: _i g6
Legal Description: City, ST, Zip: LAC�4
Contractor. OLD . 0 1 rt W.5 Telephone: b 9 -A-_2S 08 I
Address: 4-77191�,�„ ln) Project Description: f7
City, ST, Zip: SA ,) -r->_ E=7 CA TO -1.1
/ tyl
Telephone: &I q
a1i$' 4-L—AT-1®.,%
State Lia #: R7 (D% City Lie. #;
Arch, Engr., Designer:
Address:
City' ST, Zip.
Telephone:
State Lic. #:
Construction Type: - Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: j #Unit;;
Name of Contact Person:
Telephone # of Contact Person:
Estimated Value of Project: -
APPLICANT: DO NOT WRITE BELOW THIS LINE
•#
Submittal
P q'd
Reed
TRACENG
PERMIT FEES -
Plan Sets
Plan Check submitted
item Amount
Structural Calm
Reviewed, ready for conwAons
Plan Check Deposit.
Truss Colo.
Called Contact Person
Plan Check Balance -
Title 24 Cafes.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mecba Tical
Orading plan
2" Review, ready for correctionsfissue
Electrical
Subcontactor Fist
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
MO.& Approval
Plans resubmitted
Grading
IN DOUSE:-
''" Re-vlew, ready for corrections/ime
Developer Impact Fee
Planning Approval
Called Contact Person
M.P.P.
Pub. Wks. Appr,
Date of permit issue
Schodl Fees
Total Permit Fees