06-2806 (AR)P.O. BOX 1504
78-495 CALLE TAMP ICO
LA QUINTA, CALIFORNIA 92253
Application Number:
06-0.0002806
Property Address:
80415 WEISKOPF
APN:
762-090-010- - -
Application description:
ADDITION - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
20000
T4ht 4 a CPO"
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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: A B C8,27, LicenseNo.: 839002
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 ISec. 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).:
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.).
() I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
16 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 Li nse Law.l.
1 —1 I am exempt under Sec. B.&F L (dr this �ason
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:
LQPERDIIT
Owner:
M/M LEW BLACKWELL
80415 WEISKOPF
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/04/06
Contractor: D U
RIPARIAN ENVIRONMENTS
P.O. BOX 13990 OCT 031006
PALM DESERT, CA 92255
(760) 398-9997 CITY OF LAAUINTA
Lic. No.: 839002 FINAMI`mnafr
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 I/ Policy Number 1769754-2006
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 should be bject t the w kers' compensation provisions of Section
3 00 of the Labor Codd 11 fo with c ply h those provisions.
Date: LI 0 pplicant:
WARNING: 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 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 with all
city and county ordinances and state laws relating to buildin co uction, and hereby authorize representatives
of this co my t enter �pon the above-mentioned pro r r in ction rposes
Date :`n i "Signature (Applicant or Agent):
Application Number . . . . . 06-00002806
Permit
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
207.00 Plan Check Fee
134.55
Issue Date
Valuation
20000
Expiration Date
4/02/07
Qty Unit Charge
Per
Extension
BASE FEE
45.00
18.00 9.0000
----------=----=------------------------------------------------------------
THOU BLDG 2,001-25,000
162.00
Permit
ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . .
37.14- Plan Check Fee
9.29
Issue Date . . . .
Valuation . . .
o
. 0
Expiration Date
4/02/07
Qty Unit Charge
Per
Extension r
BASE FEE
15.00
204.00 .0350
ELEC NEW RES - 1 OR 2 FAMILY
7.14
20.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
15.00
Permit
MECHANICAL
Additional desc . .
Permit Fee . . . .
26.00 Plan Check Fee
6.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
4/02/07
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 4.5000
EA MECH,VENT INST/ DUCT ALT
4.50
1.00 6.5000
EA MECH VENT FAN
6.50
----------------------------------------------------------------------------
Special Notes and Comments
204 SF ADDITION TO EXISTING
RESIDENCE/V-NR/RES-3.
THIS PERMIT DOES
NOT INCLUDE BLOCKWALLS,
POOL AND SPA,_„
OR DRIVEWAY APPROACH.
October 4, 2006
9:08:20 AM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . ENERGY REVIEW FEE
13.46
STRONG MOTION (SMI) - RES
2.00
Fee summary Charged Paid Credited
Due
---------------------------
Permit Fee Fee Total
------------------------------
270.14 .00 .00
270.14
LQPERMIT
Application Number
Plan Check Total
Other Fee Total
Grand Total
LQPERMIT
. . . . 06-00002806
150.34 .00
15.46 .00
435.94 .00
00 150.34
00 15.46
00; 435.94