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12-1181 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: --12-00001181 Property Address: 77511 CALLE ARROBA APN: 774-155-022-2 -000000- Application description: ADDITION - RESIDENTIAL Property Zoning: COVE RESIDENTIAL Application valuation: 2822 Applicant: Architect or Engineer: ------------------- LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 1 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 Contractor's 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 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).: (_) 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 w s for the projects with a contractor(s) licensed pursuant to the Contractors' State License W.I. (_ 1 I am exempt under Sec. , B.&P . ,o 4s rea XDate�� �. 0 er: _ I hereby affirm under penalty of perjury that work for which this permit is issued (Sec. 31 Lender's Name: Lender's Address: LQPER,MIT s a construction lending agency for iv. C.). Owner: VARGE,RICHARD 51230 AVENIDA LA QUINTA, CA Contractor: Owner VOICE (760) FAX (760) 77 - 1 INSPECTIONS (760) 777-7153 N OCT 0 6 2011 CIT)9u LA QUINTA Date: 10/08/12 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 Policy Number I certify that, in the performso the work for which this permit is issued, I shall n employ any person in any man so as to bec a subject to thew ion s oT tallffmia, and agree tha I should be me s bjec orlk c mpen ation visions of Section 3700 It Labor Code, I all i comply with th a prov sio It USTID: WARNING: FAILURE TO SECURE W6 KERS�TOT'RPEif6AT�^^� rnvFaac'F 1 NLAWFUL AND sl3cr.✓ SUBJECT AN EMPLOYER TO CRIMI L PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001. IN ADDITION 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 is not commenced within 180 days from date of issuaZrt<r cessation of work for 1 ' L.srbjosi permit to cancellation. I certify that I have read this application and staton is correct. I agree to comply with all city and county ordinances and state laws rel tion, and hereby authorize representatives of this county to enter upon the above- boneon purposes.1�� ate: Signature (Applicant or Age_ J .. _, . rj. Application Number . . . . . 12-00001181 ------ Structure Information 144SF STORAGE SHED ----- Other struct info . . . . . CODE EDITION 2010 FLOOD ZONE NO GARAGE SQ FTG ---------------------------------------------------------------------------- 144.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 54.00 Plan Check Fee 35.10 Issue Date . . . . Valuation . . . . 2822 Expiration Date . . 4/06/13 Qty Unit Charge Per Extension BASE FEE 45.00 1.00 9.0000 THOU BLDG 2,001-25,000 9.00 ---------------------------------------------------------------------------- Special Notes and Comments 144SF STORAGE SHED [CONVENTIONAL] THIS PERMIT DOES NOT INCLUDE ADDITIONAL CONDITIONED SQUARE FOOTAGE, MECHANICAL, ELECTRICAL OR PLUMBING INSTALLATIONS, OR IS AREA TO BE USED FOR SLEEPING PURPOSES. MINOR ADJUSTMENT 2012-654 [JW] FOR REDUCED BUILDING SIDE YARD SETBACK. 2010 CALIFORNIA BUILDING CODES. October 8, 2012 8:50:05 AM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 STRONG MOTION (SMI) - RES .50 Fee summary Charged Paid Credited Due ---------- ------------------------------------- Permit Fee Total 54.00 .00 ---------- .00 54.00 Plan Check Total 35.10 .00 .00 35.10 Other Fee Total 1.50 .00 .00 1.50 Grand Total 90.60 .00 .00 90.60 11 LQPERMIT twa\Y apyWl "ne VuoHHV3T"MIL pR g!f ovK NOIS3a INOaVU Ndld VYSE)UgS V /H SIUH g d s s e g `dWSJ2l38 t/NIlSl2lHO MH 33famm LlYw_m Aq v Stem \\\\\� WIN -A 1fN1Vi7IIG� UZNNaiNO tl01M3Atl APP o BY Pt ANNINGi DEPARTMENT BY —DATE, C.0' �_- EXhIlBI _ - CASE NO. IAN 21617�_Som -t e$n IE e tl0'Ii7YJ 4 iY1'IYJ Aq v Stem \\\\\� WIN -A 1fN1Vi7IIG� UZNNaiNO tl01M3Atl APP o BY Pt ANNINGi DEPARTMENT BY —DATE, C.0' �_- EXhIlBI _ - CASE NO. IAN 21617�_Som -t