08-1915 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tit�t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
08-00001915
Property Address:
77360 CALLE DURANGO
APN:
773-162-0.12-13 -000000-
Application description:
RE -ROOF
Property Zoning:
COVE RESIDENTIAL
Application valuation:
8000
Applicant: �)
Architect or, Engineer:
JIA-
-------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penaltyof perjuryAhat 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: B-1)06 cense No.: 588602
ate: ntracto
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, after, 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 $action 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 fora permit subjectsrthe applicant to a civil penalty of not more than.five,hundred dollars ($500).:.
1 _ 1 1, -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 property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided thatrthe
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.).
I 1 1, as owner of:the property, am exclusively contracting whh,licensed contractors to construct -the project (Sec.
7044, Business and Professions Code: The Contractors' State Licenwi-awdoes 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.
(_) I am exempt under Sec. , B.&P.C. forthis reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is's construction lending agency for the performanceof the
work for which this permit is issued (Sec..3097, Civ. C.).
Lender's Name: _
Lender's Address:
LQPE tmff
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/02/08
Owner:
ARELLANO EMILIANO E
77360 CALLE DURANGO
LA QUINTA, CA 92253
Contractor:
C A CONSTRUCTIO �DD
981 IOWA AVENU ITAC 022#
RIVERSIDE, CA 2508
(951) 781-8055 Cr,�-r
Lic . No..: 5'88602 "_.
WORKER'S COMPENSATION DECLARATION
.1 hereby affirm under penalty of perjury one of the following declarations:
_ I
have -and will maintain a certificateof 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'arx) 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 1641260
_ 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 subjectto the workers' compensation laws of'California,
andegree that, if.l.should become subject to the workers' compensation: provisions of, Section
3700 "of th abor Cod loll o it cont 1y with those provisions.
ppl(car -
WARNING:. FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND,SHALL
SUBJECT AN EMPLOYER70 CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS (9100,000). 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 fora 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 perm_ it: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 withall
citYancounty, ordinances and state laws relating to building construction, :and hereby authorize representatives
ofpK county to enter upon a above-mentioned property f - e%$Urposesit .
Date: nature (Applicant or Agent .:
Application Number . . . . . 08-00001915
Permit . . . RE -ROOF INV FEE
,Additional desc . .
Permit Fee . . . . 60.00 Plan Check
Fee
.00
Issue Date . . . . Valuation
. . .
. 0
Expiration Date 5/31/09
Qty Unit Charge. Per
Extension
BASE FEE
60.00
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Special and Comments
--------
-Notes -
REMOVE TILES, SHEET ROOF AND RE -SET
TILES. INVESTIGATION FEE ASSESSED PER
1997 UNIFORM ADMINISTRATIVE CODE §304.5
FOR WORK BEGUN WITHOUT BUILDING PERMIT.
Fee,summary Charged Paid Credited
---------
Due
----------
Permit Fee Total 60.00 .00
---
.00
----
60.-00
Plan Check Total .00 ..00
.00
.00
Grand Total 60.00 .00 -.00
60.00
LQreRnur
Bin #
Permit #
`5
Project Address:
A. P. Number:
City of La Quinta
Building a Safety Division
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (760) 777-70.12
Building Permit Application and T=racking Sheet
Owner's Name:
Address:
Legal Description:
City, ST, Zip: &1,4A CA R 73
Contractor:CA
Address:TV T&z V•C
City, ST. Zip.
i O Telephone.:
'Project Description: 19-0,m bye -i f s
9Z&—b7 ' Se S
Telephone:
State Lic. /! : S84A"City.
#:
Arch., Engr., Designer.
Address:
City, ST, Zip:
Telephone:
State Lic. #:.Project
Name of Contact Person:
onstruction Type: b 0 ,� Occupancy:
type (circle one): New Add'n Al Repair Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person:
# Submittal Req'd
Estimated Value of Project: b 0 a
APPLICANT: DO NOT WRITE BELOW THIS LINE
Recd TRACKING , PERMIT FEES
Plawsets
Plan Check submitted Item Amount
Reviewed, ready for corrections Plan Check Deposit
Structural Caks.
Truss Caks.
Called Contact Person Plan Check Balance
Energy Calcs.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
Grading pian
2" Review, ready for cormetionsfssue. Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.WLI.
MO.A. Approval
Plans resubmitted Grading
IN HOUSE_-
3' Review, ready for corccetionstissue Developer Impact.Fee
Called Contact Person A.LP.P.
Date of permit issue
Planning Approval
Pub. Wks. Appr
School Fees
Total Permit Fees