05-0683 (AR)Ck
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
05-00000683
51565 AVENIDA CARRANZA
773-124-016-4 -000000-
ADDITION - RESIDENTIAL
COVE RESIDENTIAL
18533
Tiht 4 lwQ"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
tD ..
M.AY 2 5 2005
CITY OF LA QUINTA
FINANCE DEPT
Architect or Engineer:
0IA
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, anA my License is in full force and effect.
License Class: B )icen I se N 732083
.,�ate:•L • 6ntractor•
OWNER -BUILDER DECLA ATION
I hereby affirm under penalty per' y that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, siness and Professions Code: Any city at 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 Contractor's 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).:
1 _ 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
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 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.).
1 _) 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 owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
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: N
LQPERN11T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/25/05
Owner:
CROSS MICHAEL G
51565 AVENIDA CARRANZA
LA QUINTA, CA 92253
Contractor:
SHARPE CONSTRUCTION CO, J. T.
74156 ASTER DRIVE
PALM DESERT, CA 92260
(760)346-0891
Lic. No.: 732083
------------------
WORKER'S 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 E EMPT Policy Number EXEMPT
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any r so as to become subject to the workers' compensation laws of California,
and agree that, f I s uld become subject to the workers' compensation provisions of Section
3700 of the r e, hall forthwith ylLmply with th2Q provisions.
WARNING: FAILURE TO SE UR ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TT C MINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN AVIDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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 isnot 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 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 county
to enter upo a above-mentioned pr or i spection purposes
6ate-5' ignature (Applicant or Agent), �.
Application Number . . 05-00000683
Permit
BUILDING PERMIT
Additional desc .
Permit Fee
198.00 Plan Check
Fee
128.70
Issue Date . . . .
Valuation
. . .
. 18533
Expiration Date ...
11/19/05
Qty Unit Charge
Per
Extension
BASE FEE
45.00
17.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
153.00
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
26.34 Plan,Check
Fee
6.59
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
11/19/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
324.00 .0350
---------------------------------
ELEC NEW RES - 1 OR 2
------------------------------"-------------
FAMILY
11.34
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . .
33.00 Plan Check
Fee
8.25 ,
Issue Date . . . .
Valuation
. . . .
0
Expiration Date
11/19/05
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH FURNACE <=100K
9.00
1.00 9.0000
EA MECH B/C <=3HP/100K BTU
9.00
----------------------------------------------------------------------------
Special Notes and Comments
324 SF. ADDITION TO EXISTING HOUSE
----------------------------------------------------------------------------
Other Fees . . . . .
. ENERGY REVIEW FEE
12.87
STRONG MOTION (SMI)
- RES
1.85
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total
257.34 .00
.00
257.34
Plan Check Total
143.54 .00
.00
143.54
Other Fee Total
14.72 .00
.00
14.72
Grand Total
415.60 .00
.00
415.60
LQYERMIT
Unit 1 51565 Avenida Carranza
Unit 2
Unit 3
Unit 4
Unit 5
Comments
324 Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patiostwalkways, residential additions under 5
00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho
mes. It has been determined that the above-named owner Is exempt from paying school fees at this time due to the following mason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 324 S.F. or $0.00 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By Exempt -Mike Cross Check No.
Name on the check Telephone
Funding Exempt
By Dr. Doris Wilson
Superintendent
Fee collected /ex 70,
ed by Patriaia Barbuzza Payment Recd
// Over/Under
Signature
NOTICE: Pursuant to Government Code Section 08=(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o
r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which
those amounts are paid to the District(s) or to another public entity authorized to collect them on the District(s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID if Duplicated
Embossed Original -Building Department/Applicant Copy -Applicant/Receipt Copy - Accounting