05-0254 (RER)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . .
. . J05-00000254 Date
1/26/05
Property Address . . . .
... 44305 MONTICELLO AVE
APN:
604-502-027-32 -24197 -
Application description .
. . REMODEL -' RESIDENTIAL
Property Zoning . . . . .
. . LOW DENSITY RESIDENTIAL
Application valuation . .
. . 1000
Owner
Contractor
MICHAEL SHMOCHUN
OWNER......
44-305 MONTICELLO
LA QUINTA CA 92253
------ Structure Information EXTEND WALLS IN DINNING ROOM
-----
Construction Type ".
TYPE, -V - NON RATED
Occupancy,Type . . . . .
.. DWELLG/LODGING/LONG <=10
..Flood Zone . . . . . . .
. NON -AO FLOOD ZONE
Other struct info . . . .
. CODE EDITION 2001
CBC
Permit . . . . . . BUILDING PERMIT
Additional desc
Permit Fee 25.00 Plan Check Fee
16.25
Issue Date . . . .
Valuation
1000
Qty Unit Charge Per
Extension
BASE FEE
15.00
.5.00 2.0000 HND
------------------------------------------------------------------------------------
BLDG 501-2,000
10.00
Permit ELECT
- ADD/ALT/REM
Additional desc
Permit Fee . . . . •18.75 Plan Check Fee
4.69
Issue Date
Valuation.
0.
Qty Unit Charge' Per
Extension
BASE FEE
15.00
5.00 .7500 PER
-----------------------------------------------------------------------------
ELEC DEVICE/FIXTURE 1ST 20
3.75
Permit MECHANICAL
Additional desc
Permit Fee . . . .
24.00 Plan Check Fee
6.00
Issue Date . . . .
Valuation . . .
0
Qty Unit Charge Per
Extension
BASE FEE'
15.00
1.00 9.0000 EA
----------------------------------------------------------------------------
MECH APPL REP/ALT/ADD
9.00
Special Notes -and Comments—.
-
EXTEND WALL UP TO CEILING
IN DINNING
P.O. Box 1504
78-495 CALL$ TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
0 S
rwNncant s nnaning Aaaress:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 02 � /D- o.:;'Architect or Engineer.
,,vcnnecl or tngmeer'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 8 (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
I hereby affirm under persalt of OWNER$UILDER DECLARATION
Y 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 ofessi b foe 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 permits acts
"applicant to a cavil penalty of not more than five hundred dollars ($500).): subjects
VIN 1, 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. 7041,
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 1, 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 contractors) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , B-& P.C. for this reason
1 herebyaffirm under y perjury WORKERS' COMPENSATION DECLARATION
penalty ofone of the foll clarations:
_ 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:
Cartier . Policy Number
I certify that, in the performance of the work for which this pernit is issued; l shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shad
forthwith comply with those provisions.
V �! plicant__ � � �,�,� •�
WARNING: FAILURE TO SECURE WORKERS' COMP NSA N COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL
SECTION 3706 OF THE LABOR CODE, INTEREST, ANARS ($700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
D ATTORNEY'S FEES.
I hereby affirm under Halt of CONSTRUCTION LENDING AGENCY
penalty perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lenders Name
Lender's Address pC
IMPORTANT APPLICANT ACKNOWLEDGEMENT
Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on thisa
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 any permit
to
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City u Le pursuant
a, its
o
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 fro
cessation of work for 180 days will subject permit to cancellation. m date of issuance of such prmnit •or
1 certify that 1 have read this application and state that the above information is cored. I agree to comply with all city and county ordinances and stale laws rotating to building
construction, and hereby authorize re resentatives of this county to enter upon the above mentioned property for inspection purposes.
Oate Z ��' _._< Signature (Applicant or Agent): tri.•
Page
2
Application Number
. . . . .
05-00000254
Date
1/26/05
---------------------------------------------
Special Notes and
Comments
-------------------------------
ROOM 1/26/05 6:34:53
AM jjohnson
----------------------------------------------------------------------------
Other Fees . . .
. . . . . .
ENERGY REVIEW
FEE
1.63
STRONG MOTION
(SMI) - RES
.50
Fee summary
Charged
Paid Credited
Due
Permit Fee Total.
67.75
.00
.00
67.75-
7.75Plan
PlanCheck Total
26.94
.00
.00
26.94
Other Fee Total
2.13
.00
.00
2.13
Grand Total
96.82
.00
.00
96.82
B`in #
City of La Quinta
Bupd'Ing at Safety. Division
Permit #
P.O. Box 1504, 78-49S Cape Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Addrar. tA —1 �'
w l i �
c
Owner's Name;
A.P. Number
-eJl/l
�� tw�42�.x
Address -^ - _
2,0
Legal Dcscription:
X
City, ST. Zip: tti C J�
Contractor.
FTdcphone: 4Zld'e� 3 �.� 22s�
:Address N�.
City, ST, Zip: I
jectDe9cription: )
eA
X
.,2'2. _ ...Ae
,
A
State Lia # :
City Lk. #:
Arch.. Engr., Designer.
. Addr=:
City. ST, Zip: -
Telephone:
Construction Type:
State Lia #:
r�� _+
�u�ry'
1C
Name of Contact Person:
�j� type (circle one):. New Add n Alter Repair Demo
%(
Telephone # of Contact Person:
Sq. FL:
# S ries:
Units:
Value of Project..
APPLICANT:
DONOT WRITE BELOW THIS UNE
FN
Submittal
Req'd
Recd
TRACKING
Plan Sets
PERMIT FEES
Plan Check sabmitied t
Structural Gla.
Reviewed, rady for corrections.
tern
Amount
Truss Gia.
Plan
Plan Cheek Deposit
Contact Person
Plan Cheek Balance
Energy Gla.
Plans jAcked up
Flood plain plan '
Plans resubmitted
Construction.'
Grading plea
P' Review, ready.for correctio
Mechanical
Subcoatactor List
usn
(�
Electrical
filled Contact Person.
Z� of
Plumbing
-
Grant Deed •
�
Plans picked up
H.O.A. Approval
Plans resubmitted
S.M.I.
M HOUSE:-
'"' Review, ready for correctionsl�ssae
Grading
'Planning Approval
Developer impact Fee
Called Can Person
Pub. Wks. Appr
Date of permit issue,
A-I.P.P.
School Fees
1
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that as "Owner/Builder" you are the responsible party of record on such a
permit. Building permits are not required to be signed by property owners unless they are personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also required by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs) is $200.00 or more for the entire project, and such.persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer and you are subject
to several obligations include State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Administration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contracts are allowed to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits are not required to be signed by property owners unless they are performing their own, work
personally.
Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF IA QUINTA
DEPT. OF -BUILDING -AND -SAFETY
78-495 Calle Tampico
La Quinta, CA 92253'
(760) 777-7012
FAX: (760) 777-7011
O R'S SIGNATURE/DATE
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x:
Construction is Code Holidays:TCO
on the following
New Year's Day
Dr. Martin Luther Wng it. Day
President's Day
Memorial Day
Independence Day
Labor Day
Veteran's Day
Thanksgiving Day y.
Christmas Day
CONSTRUCTION gOURS
October 1st - Aprils �
Monday - Friday: 0 saed. to 5.30 pm
Saturday: 8:00 a.m. to 5:00 P.M.
Sunday: None
Government Code Holidays: None
May 1st - September 30th ,, .
Monday - Friday:6:00 a.m to 7:00 p•m-
Saturday: :00 a.m. to 5:00 p.m.
Sunday: None None
Government Code Bolidays:
°AN ADEQUATELY SIZED DEBRIS CONTAINER
IS RF"011,1! FP 0.^! THE JOB SITE DURING ALL
AND MUST BE
EMPTIL J !S Nti;tSSAKY. FAILURE
MAY CAUSE THE CITY TO HAVE THE CONTAINER
DUMPED AT THE EXPENSE OF THE OWNER/
CONTRACTOR."
p RE-INSPECTIONFEE APpRO 0
WILL BE CHARGED F E
ARE NOT 0%
,. PLANS AND !OB CARD SCHEDULED
THE SITE FOR A
INSPECTION.
NO EXCEPTIONS!