05-2381 (RR)P.O. BOX 1504 -
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05-.00002381 '
Property Address: 49825 LAGO DR
APN: 658-270-015-15 -3941 -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 25000
Ta�v 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
L,[AUG
Applicant: Architect or Engineer: 0 42005
/OF L A pVINTIANCE DEP___T.
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of per' y that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the ass and Professionals Code, and my License is in full force and effect.
Licens class:
rl� , License No.: ---------
------
ate: i' V ' Co ctor.
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).:
(_ 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(sl 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
f 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:
LQPERAM
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/03/05
Owner:
FISHER, JULIA
49825 LAGO DR
LA QUINTA, CA 92253
Contractor:
GALATI ENTERPRISES INC
WCC: STATE FUND
WC: 10681 01/01/06
CSLB: 655861 08/31/06
LiC. No.: ------
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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 B C54 Policy Number 200
I certify that, in the perfor ance of the work for which this permit is issued, I shall not employ any
person in any manner o as to become subject to the workers' compensation laws of California, .
and agree that, if I s ecome bject to the workers' compensation provisions of Section
��}�'(,��/g700 of the Labor I al sfo rith comply.with those provisions.
Dated 1 "� Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). 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 Ouinta,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 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 t e above information is correct. I agree to comply with all
city and county ordinances and state laws relating to b g ongon, and hereby authorize representatives
of this unty tto a ter upon the above-mentioned pro or ns purposes.
Date: 4 ` Signature (Applicant or AG
entl:
Application Number . . . . . 05-00002381
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
252.00
Plan Check Fee
163.80
Issue Date . . . .
Valuation . . .
. 25000
Expiration Date
1/30/06
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
23.00 9.0000
----------------------------------------------------------------------------
THOU BLDG
2,001-25,000
207.00
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
34.50
Plan Check Fee
8.63
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
1/30/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
20.00 .7500
PER ELEC
DEVICE/FIXTURE 1ST 20
15.00
10.00 .4500
--------------------------
EA ELEC
-----------
DEVICE/FIXTURE >20
-------------------------
4.50
--------------
Permit . . MECHANICAL
Additional desc .
Permit Fee . . . .
24.00
Plan Check Fee
6.00
Issue Date . . . .
Valuation
0
Expiration Date
1/30/06
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 9.0000
----------------------------------------------------------------------------
EA MECH
APPL REP/ALT/ADD
9.00
Permit
PLUMBING
Additional desc .
Permit Fee . . . .
48.00
Plan Check Fee
12.00
Issue Date
Valuation . . .
. 0
Expiration Date
1/30/06,
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
5.00 6.0000
EA PLB FIXTURE
30.00 `
1.00 3.000O.EA
PLB WATER INST/ALT/REP
3.00
-----------------------------------------------------------•--=--------------
Special Notes and Comments
REMODEL BATHROOM AND CLOSET
LQPERMIT
Application Number
. .
05-00002381
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Other Fees . . .
. . . . . .
----------------
ENERGY REVIEW
FEE
=------------
16.38
Fee summary
Charged
----------
Paid
--------------------
Credited
----------
Due
-----------------
Permit Fee Total
358.50
.00
.00
358.50
Plan Check Total
190.43
.00
.00
190.43
Other Fee Total
16.38
.00
.00
16.38
Grand Total
565.31
.00
.00
565.31
LQPEnlff _
Total Permit Fees
SOP
Bin # ` ...:.. .. . .
: City of La .Quinn
Building W Safety Division
Permit #
P.O. Box 1504,.78-495 Calle Tampico
La
i Quinta, CA 922S3 -(760) 777-7012
•
Building Permit APPlication and Tracking Sheet
Project Address: L
Owner's Name:
A. P: Number: t
Address:
.Legal Description:
City, ST, Zip:
Contractor:
Telephone:
Address: ttw
Project Description:
City, ST, Zip: Z
� S~
(iiiiiii
:Telephone: .
N d
State Lic. # : 4Ss`�C�1 :City Lic.
7 AC7a2 YAJA0 V 4J
Arch., Engr., Designer: Fe..17
I�P.eo cC'&.ucV.4e_ .v�e
Address:
Qp t
Citv, ST, Zip: P ^�� /E,e.�7 t 7 . g C4
Telephone:
Construction stru •
0 n Type: e. cu a y-
Occupancy:
t LiP
c. e -
Project circ
t}pe (circle one): New Add'n Alter Rc air
Name of Contact Person: /� P Demo
awo
.
,-v 777~ Sq. Fl.: E#S7tories;7:
L#:U:niEts:
Telephone # of Contact Person:
Estimated Value of Project: SbOo �W
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Rcq'd Rec'd
TRACKING
PERMIT FEESPlan Sets
Plan Check submitted
Item
Amount
Structural Cates. Reviewed, ready for corrections
Plan Check Deposit
T�ussCalcs.
.Called Contact Person
Plan Check Balance
Title 24 talcs:
Plans Picked up .
Construction
Flood plain plan
Plans resubmitted
�Lechanical
Grading plan
2" RevieA-, read} for corrections/issue Electrical
Subcontactor List Called Contact Person �j
Z� 3 Plumbing
Grant Deed
Plans picked up
S.1 U.
H.O.A. Approval
Plans resubmitted
Grading
IN I[OUSE:-
Review,
ready for correctio /issue Developer Impact Fee
Planning Approval
Called Contact I' son E�
A.I.P.P.
Pub. Wks. Appr Date of permi issue
/ �Jv
School Fees
Total Permit Fees
SOP