04-4867 (PLBG)'BUILDING & SAFETY DEPARTMENT
P:0 SoX 1504 p �ti • (760) 777-7012
78495 CA'LLE�TAMPICO
FAX (760) 777-7011
LA QUINTA, CALIF.OiNIA 92253 INS:PECTION'REQUESTS (760) 777-7153
BUILDING. PERMIT^
Application Number
x.04: 00.0-0.4.8 Mt Date
6/10/04
Property Address
543:61 OAK HILL
APN :
7 7 5 -,0 61 0,03-
,03 -Application
Applicationdescription
PLUM.BTNG.
.Property Zoning
-LOW-DENSITY RESIDENTIAL
Application valuation
_ 5Oh0.
Owner.
Contractor•-..
-------------------- -. --�-
► b
--=--.--------- - ----- -
_.
- --
LAMPONE MARIE
CORTEZ, & ASSOCIATES
-54361, OAK_ HILL
-7.847'- SVL BOX
LA QUINTA _ CA 92:253
UVC. TORUILLEk
CA 92392
WCC., STATE FUND
WC 177015504
01/01/05
CSLB: ;:651'042-
07/31/04
-.'CCC: --C3 6
,-
Permit. . . . . . PLUMB-ING
=�
Addtional.desc'.
Permit Fee 22.50 Plan Check Fee
5.63
Issue Date
Valuation
0
Qty Unit Charge Per
Extension
BASE, FEE ` a
15.00
1.00 7. 5 0 0 0 "EA e PLBn WF;TER HEATER/ VENT�� ' ��. '�
. ', 7. 0
- - - - - - - - - - - - - - - - - - - - - ~ -
- - - - - - - - - -- R - - - - - - - - -
- - - - - - - - - - - -
•Special Notes and Comments
h4.• = r
WATER HEATER CHANGE OUT
Fee summary Charged'
---------- =----.--
Pa%d# r •Credited
Due
---- --
Permit...Fee Total 22:50`
--.---_-------=_---------
00 r. 00
- - - - --
22.50
Plan Check Total 5.63
.00 00
5.63
Grand Total 28:131b
.00.,•. 00
28.13
P.O. BOX 1504 '��
78-495 CALLE TAMTICO � VOICE (760) 777-70i.
LA QUINTA, CALIFORNIA 92253 4VFAX (760) 777-701 ;
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-71 c;
Application Number:('j C,� - f� 7 &' �� - U
Applicant: Date: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Al
Lic. No.
BUILDING PERMIT DECLARATIONS
I hereby affirm under penalty of LICENSED CONTRACTOR'S DECLARATION
Y oAe a that I am licensed under visions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my Licensej�i= fo a and effect.
/C censer Class ,CC.=/ (7 cense No. 6 . r O Z
Date
I hereby affirm under persalt of OWNER -BUILDER DECLARATION
Y perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professrons 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 o1 not more than five hundred dollars (SSW).):
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 Crpo a or(s) licenced pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. . BA P.C. for this reason
Date - Owner
I hereby affirm under persalt of WORKERS' COMPENSATION DECLARATION
Y 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
�SyA orkeompensatione carrier and policy n r
,--carrier / tl, r Gl ,/L i colicy Number
_ I certify that, in the perfornance of the work for Pich this
permit is issued. l shall not em lot any person in any manner so as to become subject to the workers'
compensation laws of hosepr viand ag t I. if I should become s to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
fort comply with those provision
/Date /O Applicant1
WARNING: AILURE TO SECURE WORKERS' COMPENSATION COVERAGE I 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.
I hereby affirm under penalty of perjury that there is a construction lending agency orlthe Performa AGENCY
of the work for which this
Lender's Name permit Is issued (.See. 3007, CN. C.).
Lender's Address
IMPORTANT APPLICANT ACKNOWLEDGEMENT
Application is hereby made to the Director of Building and Safety or a permit subject to the conditions and restrictions set forth on this applc
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of a ion. itsication.
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
Qui
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 perniL 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 info is correct I agree t —may with all city and county ordinances and state laws relatinggto-building
construction, nd hereby authorize representatives of this county to to un a
.on ProPe►tY for inspection purposes.
to O Signature (Applicant or Agent):