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DSF (07-1214)
Tjht, 4 4, a P.O. BOX 1504�" I . VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA' 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 4/20/07 Application Number: t 07-90-0-0.1214 Owner: Property Address: 57325 MERION GERALD & MARJORIE BURNETT R APN: 762-031=018- _ - 57349 MERION I] Application description: DEMO - SINGLE FAMILY LA QUINTA, CA .92253.E Property Zoning: LOW DENSITY RESIDENTIAL { Application valuation: 0 APR P. 0 2007 Contractor: CITY OF LA QUINTA Applicant: Architect or Engineer: EDWARDS CONSTRUCTION, BOB FINANCE DEPT. 51455 DESERT CLUB DRIVE LA QUINTA,.CA 92253 (760)777-8202 A Lic: No.: 684857 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: - Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided L�Cl;: L'p enseNo.: 84857 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ,,,�,issued: ractor: 0tJc"y l v _ ( Y 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 GRANITE STATE Policy Number 3368904 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 notemployany 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 should become subject the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or, 300 of the , I s atl,forthwith omply with those 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 thanfivehundred dollars ($5001: ate: U pplican�—� (_ 1, 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION.TO'THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building orimprovement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ' 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.). _ 'APPLICANT ACKNOWLEDGEMENT (_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf .this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, I—) I am exempt under Sec. B.&P.C. for this reason 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. ' Date: Owner: 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 • CONSTRUCTION LENDING AGENCY permit to cancellation. - hereby affirm under penaltyofperjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). Pate:' ty and c ty ordinances and state laws relating to building construction, and he eby authorize representatives • - thi ou y to nter upon he above-mentioned p�p•e��v for ins coon pur and Lender''s Name: 0 nature (Applicant or Agen� i✓CI ` M Lender's Address: . . LQPERMIT Application Number . . . . . 07-00001214 Permit . . . DEMO PERMIT Additional desc . Permit Fee . . . 45.00. P1an.Check Fee .00 Issue Date Valuation 0 Expiration Date : 10/17/07 Qty' Unit Charge Per Extension BASE FEE- 45.00 --- Special Notes and Comments --- ----------------------------- -. DEMO INTERIOR AREAS ONLY IN PREPARATION FOR RESIDENTIAL REMODEL Fee summary, Charged Paid Credited Due Permit Fee,Total' 45.00 .00 .00 45.00 Plan Check Total ..00 00 .00 .00 Grand Total 45.00 .00 00 45.00 C "LQPERMIT - . Building Addressss57-325 Herich Sunrise Company Mailing AddreSS42-60 0 Cook Stmet Sure 200 City Zip Tel. P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 . Pain Desert 92254 568-2828. Contractor Hational Nortgage & Land Address Sarne State Lic. & Classif. 288134 -Arch., Engr., Designer Address Zip I Tela Lic. # 398 Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7(100) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, Improve, demolish, or repair any structure, prior to its Issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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 (E500). ❑ 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon and who does such work himself or through his own employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-buflder will have the burden of proving that he did not build or improve for the purpose or sale.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to'the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec.. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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 California Date Owner NOTICE TO APPLICANT: If, after making this Cer ffwate of Exemption you should become subject to' the Workers' Compensation provisions or the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Cin? Code.) Lenders Name Lender's Address This is a building permit when properly filled out, signed and validated; and is subject to expiration if work thereunder is suspended for 180 days. ' I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives ,of this city to enter the above•. mentioned property for inspection purposes. Signature of applicant Date' _ Mailing Address City,. State, Zip E No'. 47253 L� BUILDING: TYPE CONST. OCC: GRP. A.P. Number PGA Legal Description Tract 24801 " Phase 5H-- Plan 41 B Project Description Sq. Ft. 2899 Size • No. No. Dw. Stories Units New ❑ Add ❑' Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $214,923 .PERMIT AMOUNT Plan Chk: Dep. Plan Chk. Bal.' Const. sA • .. wA Mech. 4r • W W .. Electrical a��• ~�©• Plumbing S.M.I. a. Grading Driveway Enc. _�•., . Infrastructure 9q i:4 ZI Eo 1t' U.11 %,. 2,417.669 1I1iTCit Due $2,41789 k . w .a TOTAL s REMARKS -x�,� �;, ,,ems. .max n=ah� art ZONE: ' BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR 2/ 28/90 Issued by: Date Permit Validated by: Validation: f CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS 2ND FL. SO. FT. COLL. AREA YARD SPKLR SYSTEM ROUGH PLUMB. SVC. BAR SINK POR. SO. FT. @MOBILEHOME HEATING (ROUGH) GAR. SO. FT. ® POWER OUTLET ROOF DRAINS ROUGH WIRING DRAINAGE PIPING CAR P. I SO. FT. DUCT WORK ROCK STORAGE WALL SO. FT. AS (ROUGH) DRINKING FOUNTAIN. SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ OTHER APPJEOUIP. WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTOXDISH) APPLIANCE DRYER SERVICE GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRY TRAY AIR HANDLING UNIT CFM WATER SYSTEM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11A c SEWAGE DISPOSAL SO.FT.GAR ® VAc HOUSE SEWER VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE 7NST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBIN . UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS EWER ORST-IC ROUGH WIRING DUCT WORK ROCK STORAGE OUND. REINF. �� ZZZ AS (ROUGH) %1 �{ METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ =$ LUMBER GR. / FINAL INSP. - -� //;,2 l e4KFRAMING 3 �/� FINAL INSP. 7 ROOFING REMARKS VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING 2 MESH INSULATION/SOON LLL FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS ' GARDEN WALL FINAL 1