07-0448 (RR)P.O: BOX 1504
78-495.CALLE TAMPIC0
LA,QUINTA, CALIFORNIA 92253
Application Number:
07-00000448 '
Property Address:
53180 AVENIDA VALLEJO
APN:
774-053-009-16 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:
5000
Applicant: 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: License No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
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 Codel,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).:
1 _ 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.).
(_ 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 L .).
(_) I am exempt under Sec. , B.&P.C. f , kiiis reason�rl e Q
Date:
I ..J l nV V I IMY LC1YVIrvU NlaCrvl.T
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:.
STEVEN A. GOODSELL
53-180 AVENIDA VALLEJO
LA•QUINTA, CA 92253
(760)564-0274
{
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/09/07
Contractor: Q
Owner
FFA 09 X001
WORKER'S COMPENSATION DECLARATION
I 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 - - - - - - - - - - - - - - - - - - - - - -- Policy Number
certify that, in the performance of the work for which this permit i Wprn
ploy any
person in any manner s as o become subject tot workers' california,
and agree that, if I shout b come subject to the r ars' compection
3700 of the Labor Code I all forthwjth, mply i those pro
Dat Applicant:
WARN N: 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 wXe
permit to cancellation.
certify that I have read this application and state that the abov inf anon is correct I)eejc
city and c unty rdinances and state laws relating to building co t tion, and ereby rit
ofthis co ty enter upon the above-mentioned property for in c on pur
Dater ignature (Applicant or Agent):'
i ' . - .
LQPERMIT
z
Application Number 07-00000448
Permit . . . RE -ROOF
Additional desc .
Permit Fee . . . . 30.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
0
Expiration Date 8/08/07
Qty Unit Charge Per
Extension
BASE
FEE
30.00
--------------------------------------
Special Notes and Comments
-----------------
------
---------------
RE -ROOF ASPHALT SHINGLES CLASS A
MATERIAL ONLY.
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
LQPERMIT
z
Bin #
Permit # t ��
tl�l,
Project Address: 1 - (
A. P. Number:
Legal Description:
Contractor:
Address:
City, ST, Zip:
Telephone:
State Lic. #
Arch., F.ngr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Name of Contact Person:
Telephone # of Contact Person:
# • Submittal
Plan Sets
Structural Calcs.
Truss files.
EneW Calcs.
Flood plain plan
Grading.pian' '
Subcoutactor List
Grant Deed
H.O.A. Approval
IN HOUSE:-
Planning Approval
Pub. Wks. Appr
School Fees
u
City Of La Quinn
Building U Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Lic. #:
Owner's Name:. p (i
Address:
e_
City, ST, Zip. e t Q
Project
-e-
W
Total Permit Fees
Construction Type:
Occupancy:
PrOject hype (circle one):
New Add'n Alter Repair Demo
Sq. Ft:
#Stories:
#Units:
Estimated Value of Proj
APPUCANT:
DO NOT WRITE BELOW
THIS UNE
Recd
TRACI�iG .
PERMIT FEES
Plan Check submitted
tem
Amount .
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans bicked.ap
Construction
Pians resubmitted
Mechanical
2" Review, ready for correction&%sue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.L .
Plans resubmitted
Grading
Review, ready for.correctionstissue
Developer Impact Fee
Called Contact Person
A.LP.P.
. Date of permit issue
Total Permit Fees