The URL can be used to link to this page

04-5553 (AR)54775 Avenida Alvarado -1114111 25 Ceilif 4 IE 0141 P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number Property Address BUILDING PERMIT INSPEC BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760)_7_37-7011 (760) 7-7153 N REQiESTS AUS 0 41004 ,04-00005553– art utemeA 54-775 AVEN I DA 7IA APN: 774-292-030-4 -000000- Application description ADDITION - RESIDENTIAL Property Zoning COVE RESIDENTIAL Application valuation 763 Owner LOCKARD T SWIFT 84-7)5 Ai& A✓A vo intrtrmr-Lig quiAt r4 CA DDD -99 g2133 Contractor 8 03/04 SANTA ROSA BUILDERS, INC. P.O. BOX 11335 PALM DESERT CA 92255 WCC: STATE FUND WC: 177037904 01/01/05 CSLB: B 10/31/04 CCC: 814110 Structure Information Construction Type TYPE V - NON RATED Occupancy Type DWELLG/LODGING/CONG <=10 Other struct info CODE EDITION 2001 ' FLOOD ZONE NO ' FIRST FLOOR SQ FTG 13.00 Permit Additional desc Permit Fee Issue Date BUILDING PERMIT 21.00 Plan Check Fee . . 13.65 Valuation . . Qty Unit Charge Per BASE FEE 3.00 2.0000 HND BLDG 501-2,000 763 'Extension • 15.00 6.00 Permit ELECT - ADD/ALT/REM Additional desc Permit Fee . . 15.49 Plan Check Fee 3.87 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 14.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY .49 Permit MECHANICAL Additional desc . P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Tay/ ot 4 adna BUILDING & SAFETY DEPARTMENT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: Q 5 553 Applicant: Applicant's Mailing Address: Architect or Engineer: Date: s-4-Ogi Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 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 Code, and my License is in full force and effect. License Class License No. Date Contractor OWNER -BUILDER DECLARATION I 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.). 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 owne • •roperty 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.& - . r this r- -s ate 8/I JO4 caner 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. 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 Policy Number 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 Califomia, and - • -1, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisio - - ate d plicant 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. 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 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 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 the above info • on is ect. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this count = - - •on th abov--mentioned property for inspection purposes. Signature (Applicant or Agent): Page 2 Application Number 04-00005553 Date 8/03/04 Permit Fee . . . 1950 Plan Check Fee . . 4.88 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/DUCT AL 4.50 Special Notes and Comments REVISION TO BEDROOM (,14- Q.FT. ADDITION)LAYOUT. SUPPLEMENTAL TO ISSUED PERMIT 04-4768. TYPE VN CONSTR. 2001 CODES. bigio Other Fees ENERGY REVIEW FEE 1.37 HOURLY PLAN CHECK 140.00 STRONG MOTION (SMI) - RES .50 Fee summary Charged Paid Credited Due Permit Fee Total Plan Check Total Other Fee Total Grand Total 55.99 22.40 141.87 220.26 .00 .00 .00 .00 .00 .00 .00 .00 55.99 22.40 141.87 220.26