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12-0547 (RER)N__ P.O._- P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Applic2,tion Number: 12-00000547 Property Address: 50455 VIA PUENTE APN: 772-370-033- - - Application description: REMODEL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 10000 Tit!t °F4Q" 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 C tle, and my License is in full force and effect. License Class: B �at>1"8@9021 Date: '5;'-/ 7 /ZContractor: 29 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 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, 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. 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. , 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: LQPERMIT Owner: PECONI,ELAINE PO BOX 1100 CEDAR GLEN, CA TRUST 92321 Contractor: RAAB CONSTRUCTIO 1100 W. KATELLA ORANGE, CA 92867 (714)997-7117 Lic. No.: 889021 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/16/12 ----------------------------------------------— 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 00046-655-2011 _ 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 become subject to the workVI com en at on provisions of Section ��(( r 3700 of the Labor Code, I shall forthwith comply to provisions. KDate7�(7/LApplicant: WARNING: FAILURE TO SECURE WORKE ' 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 Quints, 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. 1 agree to comply with all city and county ordinances and state laws relating to building co u (tion, and hereby or' resentatives of this county to enter upon the above-mentioned property fo c p poses. 'Date: C?/7?-signature (Applicant or Agent): Application Number . . . . . 12-00000547 ------ Structure Information COMPLETE EAVE REMODEL [ENGINEERED] ----- Other struct info . . . . . CODE EDITION 2010 ---------------------------------------------------------------------------- Permit . . . BUILDING PERMIT Additional desc . . Permit Fee 117.00 Issue Date . . . . Expiration Date . . 11/12/12 Plan Check Fee . . 76.05 Valuation . . . . 10000 Qty Unit Charge Per Extension BASE FEE 45.00 8.00 9.0000 THOU BLDG 2,001-25,000 72.00 ---------------------------------------------------------------------------- Special Notes and Comments COMPLETE EAVE REMODEL [ENGINEERED] REMOVE EXISTING FOAM TRIM AND REPLACE WITH FLAT EAVE. THIS PERMIT DOES NOT INCLUDE ALTERATION OF ANY ELECTRICAL, MECHANICAL OR PLUMBING INSTALLATIONS. 2010 CALIFORNIA BUILDING CODES. May 16, 2012 3:29:00 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . ... . . . . BLDG STDS ADMIN (SB1473). 1.00 STRONG MOTION (SMI) - RES 1.00 Fee summary Charged Paid Credited ------------------------------ Due --------------------------- Permit Fee Total 117.00 .00 .00 117.00 Plan Check Total 76.05 .00 .00 76.05 Other Fee Total 2.00 .00 .00 2.00 Grand Total 195.05 .00 .00 195.05 LQPERMIT I Bln.# Crijr of Lel Qulfitd Building a Safety Division P.O. Box 1504,78-495 Cage Tampico 1.a.Quinta, CA 92253 - (760) 777-7012 �jl�j Building Pen -nit Application and Tracking Sheet Permit # 12. O I1 Project Address: V 'YA(,� L A !f Q��` Owner's Name:. e- C (9i'7 )' A. P. Number. Address: Legal Description: City, ST, Zap. Contractor. (� � �� C_d''(� � �e7C� ' Telephone: .�,�...:Y•�• �.�� . Address:�j�� l%� � f �G� IT C / Project Description: G �e / e Ck City, ST, Zip:%�►� / C ' • �O� (� O)/ e ► )� ✓� Telephone:per State Lia 1: Arch., Engr., Designer: Address: City., ST. Zip: Telephone: State Lia #: - r Name of Contact Person: Construction Type:. Occupancy: Project type (circle one): Now Add'n Alter Repair Demo Sq. FL: # Stories: #Unit s: Telephone # of Contact Person: n ted EstimaValue of Project: 4 t'! APPLICANT: DO NOT WRITE BELOW THIS UNE B Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit. Truss Cala. Called Contact Person Plan Check Balance. Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan Z'! Review, ready for correeGons/issue Electrical Subeontactor List Called Contact Person Plumbing Grant Deed Plans picked up &ry L H.O.A. Approval Plans resubmitted Grading IN HOUSE:. Review; ready for correctio a Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees . d . 5 �t�l ?SCL • dl� t0 tSSwc +�J' S'immtvetl Chtay�n�� Co�{�u'[ AroOR.�S I