10-0090 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000090
Property Address:
54205 AVENIDA DIAZ
APN:
774-194-023-11 -000000-
Application description:
REMODEL - RESIDENTIAL
Property Zoning:
COVE RESIDENTIAL
Application valuation:
7000
T4'�l 4 4 Q"
Applicant: Architect or Engineer:
LICENSED -CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
1 hereby affirm under penalty of perjury that I am license under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Profes onals Co d my License is in full force and effect.
License Class: B i Lic o.: 767126
Date: j�j' ;&`Contra tor. —,
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, Busi ss and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolis , or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed stateme2 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).:
(_ 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, thr..nwner-builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.l.
(_ 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.).
( ) 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:
COWAN DIANA B
8320 VICARA DR
ALTA LOMA, CA 91701
(
Contractor:
EXCELSIOR CONSTR & DESIGN,
2430 N. GLASSELL STREET, #
ORANGE, CA 92865
(714)758-1153
Lic. No.: 767126
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/12/10
-----------------------------------=-----------
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 1423306
certify that, in the performance.ef-t work for which this permit is issued, I shall not employ any
person in any manner so as to bete a subject to the workers' compensation laws of California,
and agree that, if�should becomes bject to the workers' compensation provisions of Section
3700 of the Lab - r Code, I shall f hwith comply those provisions f
Date: KL bi'dCAPPlican • VL/�
WARNING: FAILURE TO SECURE WO ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITI N 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 thea eve infor ation is correct. I agree to comply with all
city and county ordinances and state laws relating to b ding constru ion, and her authorize representatives
of this county"to enter upon the above-mentioned p perty for insp ion purpos
Date: iG gC
Signature (Applicant or Agen /+
Application Number . . . . . 10-00000090
------ Structure Information MISCELLANEOUS IMPROVEMENTS SITE/STRUCT -----
Other struct info . . . . . CODE EDITION 2007/2008
--------------------------=-------------------------------------------------
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . . .
0
Expiration Date 8/11/10.
Qty Unit Charge Per
Extension
BASE FEE
15.00
4:'00 .7500"PER ELEC DEVICE/FIXTURE 1ST 20
------------7---------------------------------------------------------------
3.00
Permit . . . PLUMBING SEWER
Additional desc . .
Permit -Fee . . . . 30.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . . .
7000
Expiration Date 8/11/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 15.0000 EA PLB BUILDING SEWER
-------------------------------------------------- -------------------------
15.00
Permit . . . WALL/FENCE PERMIT
Additional desc . .
Permit Fee . . . . 54.00 Plan Check Fee
.00
Issue Date . . . . Valuation . .
2256,
Expiration Date . . 8/11/10
Qty Unit Charge Per
Extension
BASE FEE
45.00
1.00 9.0000 THOU BLDG 2,001-25,000
9.00
----------------------------------------------------------------------------
Special Notes and Comments
MISCELLANEOUS IMPROVEMENTS TO SITE AND
STRUCTURE - 2007 BUILDING/2008 ENERGY.
-SEWER"CONNECTION/SEPTIC ABANDONMENT
-CMU PROPERTY LINE WALLS [SIDE - 53LF AT
- -
6' HIGH + 1OLF AT 5' HIGH/FRONT - 33LF
AT 5' HIGH]
-ELECTRICAL AT CMU PILASTERS (2) AND
GARAGE (2) .
February 12, 2010 12:35:37 PM AORTEGA
-----------------------------------------------------------------=----------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
LQPERMIT
Application Number
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
LQPERMIT
. . . . . 10-00000090
Charged Paid Credited Due
102.00 .00 .00 102.00
4.50 .00 .00 4.50
1.00 .00 .00 1.00
107.50 .00 .00 107.50
Bin #
City of La Quinta
Building &r Safety Division
Permit #
P.O. Box 1504, 78-495 Calle Tampico
Q
La Quints, CA 92253 - (760) 777-7012
fl
Building Permit Application and Tracking Sheet
Project Address:
Owner's Name:
A. P. Number:°
Address:
Legal Description:
City, ST, Zip: CA c3p i -70,
7Q/
Contractor:
Tel hone raL
Address:`per' Project Description:
City, ST, Zip: Q �) • r''
�� O '
Telephon • `Zl 4) '7156
State Lic. # : 7 1
City Lie. #;
Arch., Engr.; Designer.
Address:
City, ST, Zip:
/ Q LATS lS1R r!' _-&K£
Telephone:
c
ConOccupancy:struction Type: , / Occupancy:
rf r,7'3 r v
State Lie. #: e
=x `a
�n .:5,.:...'r.: .;:fww-:•:,r::•A.Pro]ect (circle one): New Add'n A. Repair Demo
Name of Contact Person:
J'
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Proj
151
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cala.
Reviewed, ready for corrections Plan Check Deposit
Truss Cala.
Called Contact Person Plan Check Balance
Tide 24 Cala.
Plans picked up Constructionr
Flood plain plan
Plans resubmitted Mechanical
Grading plan
21w. Review, ready for correctionstissue 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
M;
P)