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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 `ASI,-?r0S'�Mc-N^c�211� lam—� c.� EL; eAZz PROPERTY ADDRESS PERMIT NUMBERS) T1,7,111, oc cw c -r_ I or - j cy- UG _ I -- I I i • � I I i I _ .... � CITY OFLA QUI TA N BUILDING & SAFETY DEPT. i �CON�STORUCTIO i. 7 FOR N f 1 I I I lo �laY �i � 1JlXt'ji.u� J I I 11 lb oc. 4 .Sid �'':. "::b�: .vs.•S1C': .. � ' .. r ' 1 i m'. M 4050 AL K I LO �. �$j[j iO .. .... ` w Z , .. GiY11.,�F74g� • s; is b g-ril ■ b roue : �::�,.1,•,1S.s•. T "`0'.r �ir•v^.�� F.' • 11•-10' - 2,�, i,6.,0. ac` Yj�L � � � nl.. 4 P ,� * 'j�:'• �i^Q. � � i A IL • •..��a R �':''` v � � �I � rn '�'?'. •. c� I I S 0 Iii F i ko r, D W e I I O A R iil•414 � C "• d �' � Q 7p .IIS 3 m �M 0 1 r•::r. ,b`Yt;f...•� � � � .. .. .. ., �. Y,.1 H:..Kofi .n«,. .. .._ . 94•'40. rd 1 �Yna4' i y a ,c. ��• • ' 4f 1 4 1. � 3 'r ':f dia{ ?i.� F r•r a. (��,,.� „ do..g t �4' .r'',; .� `h�,,- x• .:•y cq�r'IfC!-� -:Kv rv- 1 1} L - `E f'•yT�: - 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!