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05-0155 (RER)10 JAN 18 IN5 BUILDING & SAFETY DEPARTMENT P.O..Box 1504 (760).77777012 78-495 CALLS TAMPICO FAX (760) 777-7011 L-A= UINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application description Property Zoning Application valuation 05-0000015.5 —_% Date. 1/18/05 54073 OAK HILL 775-061=042- - - REMODEL.- RESIDENTIAL. LOW DENSITY RESIDENTIAL. 3000 Owner Contractor.. DENYS MERRIMAR MERRIMAN'S INCORPORATED RIMVIEW COURT P.O. BOX 547 YUCAIPA CA 92399 CALIMESA CA 92320 (909) 795-5301 WCC: STATE FUND WC: - 4670000455 04/01/05 CSLB: 292346 02/28/06 CCC: B-C47D15C39D41 Other struct info . . . . . CODE .EDI'T'ION 2001 Permit . . . . BUILDING PERMIT Additional desc . .Permit Fee 54.00 Plan Check Fee 35.10 Issue Date Valuation 3000 Qty Unit Charge Per. Extension BASE FEE 45.00 1.00 9:0'000 THOU BLDG 2,001-25,000 9.00 Permit ELECT - ADD/ALT/REM Additional desc Permit Fee 15.00 Plan Check Fee 3:75 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 ---------- 7 -------- ------------- -------------------------------------------- Permi.t PLUMBING Additional desc Permit Fee 18.00 Plan Check Fee 4.50 Issue Date Valuation 0 Qty Unit Charge. Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments REPAIR OF WATER DAMAGE/DRYWALL REMOVE/REPLACE/RELOCATE P.O. BOX 1504 • 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT tAppiicatlon Number: — y/ Applicant: .� Applicant's Mailing Address: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architect or Engineer: Architect or Engineer's Address: Lic. No.: t$UILUINU PERMIT DEC I hereby affirm under penalty of perjury that I am licensed under Code, and my License.n full force and effect. License Class r ,& - A Licen a Date �a `� L5�' Contractor LICENSED CONTRACTOR'S Provisions of Chapter 9 (comr sAo. a -.�2 -3yz TIONS RATION with Section 7000) of Division 3 of the Business and Professionals OWNER -BUILDER DECLARATION hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 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 or 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.). U 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.). U I am exempt under Sec. , B.8 P.C. for this reason Date WORKERS' 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. _ 1 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' ompensation insurance carrier and policy number�r� Carrier-�'Z.�� Policy Number ©� 4 7 �^j �U _ I certify that, in the performance oft� work for which this permit is i ued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California agree that, if I should be a subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Prov io s. `Date-0Applicar WARNING: FAILURE TO SECURE WORKERS�MPENSATION 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. 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 APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Buildingand Safety fo a s set forth on this 1. Each person upon whose behalf this application is made, each person at we whose request a d formit subject to the r hose benefit work isflons and nperformed under or pulrsuant 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 der or following issuance of this permit. 2. . Any permit issued as a result of this application becomes null and void if work is not comm ced 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 i ormation is correct. I agree to ply with all city and county ordinances and state laws relating to building construction, and hereby autho ' e representatives of this county enter upon the above mentio d property for inspection purposes. 'Date- w Signature A 9 _ (pplicant or Agent . Page 2 Application Number . . . . . 05-00000155 Date 1/18/05 ---------------------------------------------------------------------------- Special Notes and Comments ELECTRICAL/RELOCATE GAS LINE FOR CONVERSION FROM ELECT TO GAS RANGE. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 3.51 Fee summary Charged Paid Credited Due Permit Fee Total 87.00 00 :00 87.00 Plan Check Total 43.35 .00 .00 43.35. Other Fee Total 3.51 .00 .00 3.51 Grand Total 133.86 .00 .00 133.86