Loading...
05-1176 (GRES)4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA. 92253 Application Number: 05-00001176 Property Address: 56120 RIVIERA APN: 762-021-006- - - Application description: GARAGE - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 4410. T-i&f 4 4 a" - BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: FORD; GARY 56120 RIVIERA LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7.011 INSPECTIONS (760) 777-7153 Date: 6/03/05 Contractor: Applicant: h or Engineer: EDWARDS CONSTRUCTION, . BOB D 51455 DESERT CLUB DRIVE LA QUINTA, CA 92253 O ®el®O WCC: VIRGINIA SURETY Lic. No.': B ----_--------------- -F---------------------------------------------------------------------------- LICE SED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION " hereby affirm under penalty of pe\F that I am licensed under provisions of Chapter 9 (commencing with - I hereby affirm under penalty of perjury one of the following declarations: Section 70 01 of Division 3 of the Busin s and Professionals Code, and my License is in full, force and effect. - _ (,have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License la s: License No.: B - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is '-Jt� �% issued. �te. C ractor. w �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 OWNER -BUILDER DECLARATION 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 00500027012 0 1/0 1/0601icy Number 684857 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 s d become 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 3700 of the Labo o , I al for 'th ply with tho provisions. 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).: e: pplicant: I _ ) 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.). 1 _ 11, 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 I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty ofperjury 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: LQPERA1IT 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 t1 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 th ve information is correct. I. agree to comply with all city and Co.fil ty rdinances and state laws relating to buildi��authorize representatives of this countenter upon above-mentioned prope' fes trate: 6 ignature (Applicant or Agent): LQPERMIT Application Number . . . 05-00001176 Permit CARPORT/GARAGE Additional desc . Permit Fee 72.00 Plan Check Fee 46.80 . Issue Date . . . . Valuation 4410 Expiration Date • 11/30/05 . Qty Unit Charge Per Extension BASE FEE 45.00 9 . norm TT40TT BT, -PG 2,001-25,000 27.00 ------------------- --------------------------------------------------------- Permit GRADING PERMIT Additional desc . Permit Fee . . . . . 15.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Expiration Date 11/30/05 Qty Unit Charge Per Extension BASE FEE 15:.00' --------------------------------------------------------------------------- Permit . . . PLUMBING Additional desc . Permit Fee 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 11130/05 Qty Unit Charge Per Extension BASE FEE .15.00 1.00 6.0000 EA PLB FIXTURE 6.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 -------------------------------------------------------------------- Special Notes and Comments GOLF CART GARAGEJune 3, 2005 10:19:42 •AM JJOHNSON ---------------------------------------------------------------------------- Other.Fees STRONG MOTION (SMI) - RES .50 Fee summary. Charged Paid Credited Due ----------------- ---------- ---------- ---------- ------ --- Permit Fee Total 111.00 .00 .00 111.00 Plan Check Total 52.80 .00 .00 52.80 Other Fee Total .50 .00 .00 .50 Grand Total 164.30 .00 .00 164.30