06-2390 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-00002390
Property Address:
52010 AVENIDA DIAZ
APN:
773-212-001722 -000000-
Application description:
REMODEL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
1200
T4tyl 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 Business and Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: Contractor:
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 (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
aQQQ111'''���pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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 Jgiicense Law does not apply to an owner of
property who builds or improves thereon, and who ct r t rojects with a contractor(s) licensed
pursuant to the Contractors' State License Law.l.
(_ 1 I am exempt under Sec. , B.&P.
Date:
Owner:
COf1S,7RUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there " 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:
VORWALLER SHELDON
72875 PARKVIEW DR
PALM DESERT, CA 92260
Other struct info . . .
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/14/06
0 �
Contractor:
Owner JUN 15
2006 ,
DITION 20011 07YOFLAQ A
- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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
I certify that, in the *becbj
of the work fo which this permit is issued, I shall not employ any
person in any mbeco a su ct to workers' compensation laws of California,
and agree that, iubj to t orkers' compensation provisions of Section
37 0 of the Labc ly ith those provisions.
Date: pplicant:
WAR ING: FAILURE TO SECURCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CALTIES 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 will subject
permit to cancellation.
I certify that I have read this application and state that the above infor is rr . la e to comply with all
city and county ordinances and state laws relating to building 99pW a h y orize representatives
of this county
/ to enter upon the above-mentioned
grope p n rp s.
Date �7 Signature (Applicant or Agent):
ft
LQPERMIT
Application Number . . . . . 06-00002390
Permit . . . BUILDING PERMIT
Additional desc .'.
Permit Fee . . . . 29.00 Plan Check
Fee
18.85
Issue Date . . . . Valuation
. . .
. 1200
Expiration Date 12/11/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
7.00 2.0000 HND BLDG 501-2,000
14.00
-------=--------------------------------------------------------------------
Special Notes and Comments .
REPLACE 9 4040 WINDOWS & 1 3030 WINDOW.
PROVIDED ENERGY DATA FROM PELLA SHOWS
U -FACTOR .35 & SHGC OF .29.
-------------------------------------------------------------------1--------
Other Fees . . . . . . . . . ENERGY REVIEW FEE
1.89
Fee summary Charged Paid Credited
-------------------------------------
Due
----------
Permit Fee Total 29.00 .00
----------
.00
29.00
Plan Check Total 18.85 .00
.00
18.85
Other Fee Total 1.89 .00
.00
1.89
Grand Total 49.74 .00
.00
49.74
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