04-6057 (AR)BUILDING & SAFETY DEPARTMENT
P.O.. BOx.1504.
Gl9 78- (.760) 777-.7012
OF 495 CALLE TAMPIC.O FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS" (760).777-71.53°
BUILDING PERMIT
Application Number "_0:4-00006057; D' 9/ 04
Property Address 56165 RIVIERA -�
APN:'762-021-020-
Application description ADDITION:- RESIDE L a
Property Zoning LOW DENSITY RESIDE LSf�Q.2'
Application. valuation 4508, Qu�N1..
C1F 0G A
Owner Contractor
M/M BRUCE RICHARDS EDWARDS'.CONSTRUCTION,- BOB
5.455 DESERT
CIjUB:DRIVE
-- 56165N- RI°VERIA. `
LA
: • .:: � QUINTA '. , . � :"CA :9.22:53 .:.".
LA QUINTA .. "CA '922.53 .:
WCC :: PREF =S". . .:...
.
WC:., :. :.WKN109'0403 .... `.. 01./01/05
CSLB: 684-857 03/31/06.
CCC: B
Structure Information .230 SQ'. FT GARAGE ADDITION =----
Construction Type TYPE V - NON RATED
Occupancy Type GAR, - CARPORT, SHED, AG:
Flood Zone NON-AO.FLOOD ZONE
Other struct info CODE .EDITION` 2'001 CDC:
FLOOD -,ZONE... NO.,
GARAGE SQ. FTG = . 230 . 00
Permit ....'.. ;`BUILDLNG PERMIT
Additional de-sc. `
Permit Fee 72.00 Plan Check'Fee 46.8.0
Issue .Date Valuation 4508.
Qty Unit'Charge Per. ._Extension
BASE FEE .4.5.-00.
3.00 9.0000 THOU .BLDG. 2.,001-25,000 27.00
Permit 'ELECT ADD/ALT/REM
Addi.tional.desc
Permit Fee 19.60- Plan Check.Fee 4.'.90
Issue Date Valuation 0
Qty Unit Charge Per Extension
BASE FEE 15.00
2,30.00 0200. ELEC GARAGE..OR NON-RESIDENTIAL 4.60
Special Notes and'Comments
230 sq. ft CART GARAGE ADDITION.
i
P.O. Box 1504 VOICE`(760) 777-791-2
78-495 CALLE TAMPICOFAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760)'777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: — 0c`7 Date: ' 2 % c
Applicant: Architect or Engineer:
Applicant's.Mailing Address: Architect or Engineer's Address:
IV
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm unIe enally of perjury that I am licensed under provisions of Chapter 9 corrunendng with Section 7000) of Division 3 of the Business and Professionals
and my u2 is in full force and effect.
code. Cla
�a`te V C Co r
OWNER43UILDER DECLARATION
I hereby affir 'under penalty of perjury that I am exempt from the Contractors`. State License Law for the following reason (Sea. 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 fie 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, wit do the work, and the structure Is not Intended or offered for -sole (Seca 7044.
Business and Professions Code: The Contractors' State License law does not apply to an owner of property who builds or improves thereon, aro 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 1. as owner of the property, am exclusively contracting with licensed contractors to constrict the project (Sea 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)'liicensed pursuant to
the Contractors' State License Law.).
(, I am exempt under Sea BA P.C. for this reason
Date Owner
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 W4nsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of work for which this permit is issued. .
ha and will I workers' compensation insuraffnd
required by Section 3700 of the Labor Code, for time performance of the. work for which this permit is
. My cation I Cartied y era •'
�G`-trier oiky Number ��
_ I certify that, In the performance of the work for which this permit Is issued, shag not employ arty person In any manner so as to become subject to the workers'
cormpensation laws of California; and agree that, It I should become subject to the workers' -compensation provisions of Section 3700 of the Labor Code, l shag
h bitip ith comply wdlm those provisions.
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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the•perfommance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lenders Name
Lenders Address
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 perfomhed under or pursuant to any permit
Issued as a result of this application, the owner, and the applicant, each agrees to, and shag, defend, indemnify and hold harrdess the City of La Quinta, its
officers, agents and employees for any act or omission related to the work being performed undo 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 pemdt, or
cessation of work for 180 days will subject pe ca Ilation.
I certify that I have read this application and state that the above 1 ti I agree to comply with all city and county ordinances and state laws relating to building
cons"n, n, a hereby authorize representatives of this coun t u a toned property for inspection purposes.
2
ate i nature (Applicant or Agent):
._� 14
{
Page 2
Application Number
. . . .•.
04-00006057
Date 9/27/04
Other Fees
ENERGY REVIEW
FEE
4.68
-
STRONG MOTION
(SMI.) -
RES .50
Fee summary
Charged
Paid .
Credited.
Due
Permit Fee Total
91.60
.00
.O'T
91.60
Plan Check Total
51.70
.00
.01)
51.70
Other Fee Total
5.18
.00
.04)
.5.18
Grand Total
148.48
.00
.00)
148.48.
TANDY'S
INSPECTION INC.
PO BOX 13766
PALM DESERT, CA 92255
SPECIAL INSPECTION DAILY REPORT OFFICE/FAX 909.769.9717
PAGER 760.776.3339
TYPE OF INSPECTION PERFORMED
O
SAMPLE INFORMATION
SUPPLIER
TICKET NUMBER MIX NUMBER SAMPLED AIR TEMP STEMPE SLUMP TIME IN MIXER
JDA�
�•
PHYSICAL ADDRESS
PERMIT NUMBER
PROCESS
WELDERS NAME
CERTIFYING AGENCY AND CERTIFICATION NUMBER
vy- occDo(aos—j
JOB NAM
Q
PG
STRUCTURE
ARCHITECT
ENGINEER
GENERAL CONTRACTOR
SUBCONTRACTOR
DESCRIPTION OF •' 1
IS MENEM
�7 C.711A r 7
v
I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK,
UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THISPECTORS SIGNAT E
WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE
BUILDING LAWS. i c— - c� -111-
cc:_ INSPECTORS CERTIFICATION.AGENCY AND NUMBER
SAMPLE INFORMATION
SUPPLIER
TICKET NUMBER MIX NUMBER SAMPLED AIR TEMP STEMPE SLUMP TIME IN MIXER
LOCATION
WELDING INFORMATION
PROCESS
WELDERS NAME
CERTIFYING AGENCY AND CERTIFICATION NUMBER
v
I HEREBY CERTIFY THAT I HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK,
UNLESS OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THISPECTORS SIGNAT E
WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS & APPLICABLE
BUILDING LAWS. i c— - c� -111-
cc:_ INSPECTORS CERTIFICATION.AGENCY AND NUMBER