09-1130 (RER)r�
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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BUILDING & SAFETY DEPARTMENT "
BUILDING PERMIT
(Application Number:
09-00001130
--Property Address:
52201 AVENIDA VILLA
APN:
773-233-024-9 -000000-
Application description:
REMODEL - RESIDENTIAL
Prnrairty 7nnin0•„
COLT _' REFIDENTIAL
Application valuation:
5000
Applicant:
Architect or Engineer:
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_
Code, for the performance of the work for which this permit is issued. My workers' compensation
c- !(o 30 --
VOICE (760) 777-7012
4
FAX (760) 777-7011
INSPECTIONS (76Q) 777-7153
Owner:
AMERICAN MORTGAGE
HUNTINGTON BEACH, CA 9264
Contractor: .
SOUTHERN CALIFORNIA C
81162 FRED WARING DR,
INDIO, CA 92201
(760).342-1558
Lic. No.: 688068
Date: 11/30/09
rAl
flC 02 2009
3
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION -
Ihereby affirm under penalty of perjury that I am li nsed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations: _
Section 70001 of Division 3 of the Bu P fessionals Code, nd my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
/ License Class: License o.: 6 88068
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
✓ 1
Date:/� 2. ontractor:
issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
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_
Code, for the performance of the work for which this permit is issued. My workers' compensation
OW R•BUILDE ECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier STATE FUND Policy Number 496004872
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
- construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any manner so as to become subject to the workers' compensation. laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if I should ome subject to the workers' compensation provisions of Section
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 ,.
3700 of the Labo e, I s all forthwit comply wit hose provisions.
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y
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Date: y4pplica t:. ,
(_ ) 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
WARNING: FAILURE TO SECUR KERS' PENSATION COVERA E IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, •
SUBJECT AN EMPLOYER TO CRIMINAL PENAL(' IES AND. CIVIL FINES:UP TO ONE HUNDRED THOUSAND -
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000)" IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). -
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. -
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application. _
r pursuant to the Contractors' State License Law.).
( ) 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:
LQPERntIT
—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 ove i formation is correct. I agree to comply with all
city and county ordinances and state laws relating t uildin o ruction, and hereby a horize representatives
af�this co nt to enter upon the above-mentioned roperty for ' p tion p rp ses
/Date G Signature (Applicant or Ag t):
LQPERMIT
Application Number . . . . . 09-00001130
Structure Information
Construction Type TYPE V, UNPROTECTED
Occupancy -Type GAR, CARPORT, SHED, AG
Other struct'info CODE EDITION
2007
# BEDROOMS
.00.
Permit BUILDING PERMIT
Additional desc REMODEL GARAGE
Permit Fee . . 72.00 Plan Check Fee
46.80
Issue Date Valuation•
5000
Expiration Date 5/29/10
Qty Unit Charge Per
Extension
BASE FEE.,,
45.00
3.00 9.0000 THOU BLDG 2,001-25,000
27.00
Permit . . . ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . 18.00 Plan Check Fee
4.50
Issue Date . . Valuation . . .
. 0
Expiration Date 5/29/10
Qty Unit Charge Per
Extension
BASE FEE
15.00
4.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
3.00
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Special Notes and Comments
REMODEL DETACHED GARAGE to 632.5 SF FROM
PREVIOUS UN -PERMITTED 11 FT PORTION
(305.5,SF).2007 CODES. REF CODE CASE
07-4319 .
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Other Fees . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
4.68
STRONG MOTION (SMI) - RES
•.50
Fee summary Charged Paid Credited
Due
Permit Fee Total 90.'00 .00 00
90.00
Plan Check Total 51.30 .00 .00
51.30
Other Fee Total 6.18 .00 .00
6.18
Grand Total 147.48 .00 .00
147.48
LQPERMIT