06-2413 (RER)IF
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00002413 .
Property Address:
51860 AVENIDA DIAZ
APN:
773-161-005-19 -000000-
Application description:
REMODEL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
6000
T-ityl 4 4 Q"
Applicant: . Architect.or Engineer:
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Busiand Professionals Code, and my License is in full force and effect.
License Class: C35 ne icense No.: 332907
D� Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury th 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 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, 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 Law.).
( 1 I am exempt under Sec. , B.&P.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:
BILL HOLIDAY
51860 AVENIDA DIAZ
LA QUINTA, CA 92253
Contractor:
EXTERIOR WALL DR.
P O BOX. 3143
RANCHO MIRAGE, CA 92270
(760)324-2330
Lic. No:: 332907
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/16/06
D Q
0 . 0
-JUN 16 2006
CITY OF IA QUINTA
FINANCE DEPT.
------------------
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 STATE FUND Policy Number 0729140
_ 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 shout ecome subj to the workers' compensation provisions of Section
3700 of the Labor Cod shall forth th comply with those provisions.
Datt� Applicant: (/
WARNING: FAILURE TO SECURE WORK RS' COMPE ATION COVERAGE *IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (5100,0001. 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 will subject
permit to cancellation.
I certify that '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 build' coinnstrtiouction, and hereby authorize representatives
of this countytoenter upon the above-mentioned prope r specurposes.
Data'f-� Signature (Applicant or Agent)'
II
�I
LQPERMIT
Application Number . . . . . 06-00002413
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 81.00 Plan Check Fee 52.65
Issue Date . . . . Valuation . . . . 6000
Expiration Date 12/13/06
Qty Unit Charge' Per Extension
BASE FEE 45.00
4.00 9.0000 THOU BLDG 2,001-25,000 36.00
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Special Notes and Comments
STUCCO EXISTING HOUSE. NO CHANGE TO
STRUCTURE OR WINDOWS.
----------------------------------------------------
Other Fees . . . . . . . ENERGY REVIEW FEE 5.27
Fee summary Charged
Permit Fee Total 81.00
Plan Check Total 52.65
Other Fee Total -5.27
Grand Total 138.92
Paid Credited Due
.00 .00 81.00
.00 .00 52.65
.00 .00 5.27
.00 .00 138.92
Bin #
•
City, of. La Quinta
Building 8L Safety Division
P.O: Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Address:' 60 416_,f!
Owner's NameProject
QZ/ a4l
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:&&Q2
Telephone:
Address:Arm ,
Project Description: /( J
City, ST,Zip:
w
Telephone:.
State Lie. #.:222 efb City Lie.'#:
Arch., Engr., Designer: "
Address: .
City, ST, Zip:
Telephone:
Construction. Type: Occupancy:
State Lie. #:
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 r
APPLICANT: DO NOT WRITE4 BELOW THIS LIKE. �e
#
Submittal
Req'd
Recd
TRACffiMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans bicked up :
Construction.
Flood plain plan .
Plans resubmitted
Mechanical'
Grading plan
r4 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:
''' Review, ready for correctionsrissue
Developer Impact Fee.
Planning Approval
Called Contact Person
A.I,P.P. '
Pub. Wks. Appr
Date of permit issue "
School Fees
Total Permit Fees
13