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04-5305 (AR)�u�N tl��t�iw AIL 2,00 IL r CITY OF LA QUF'' I� P.O. B70rX�ID051045L�7.� 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760),777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 .Application Number . . . . . 04-00005305 Date 7/01/04 Property Address .. . . . . . 79305 BRIARWOOD APN:_ 772-020-.019- - - Application description ADDITION - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Application valuation . 19600 Owner Contractor ZUCKER STEPHEN RUPELT CONSTRUCTION COMPANY DESERT HOT SPRINGS -.CA 92240 (760) 329-6616 WCC: EXEMPT;.. WC::, . EXEMPT. 12/31/04 CSLB: 317631 03/31/05 :. CCC: B. ------ Structure Information. CONVERT GARAGE TO BEDROOM & BATH ADD. ----- Construction Type TYPE V - NON RATED Occupancy Type . ... . . . DWELLG/LODGING/CONG <=10 Flood Zone NON=AO FLOOD ZONE Other struct info . . . . CODE EDITION 2001 CBC # BEDROOMS 1.00. FLOOD.ZONE NO FIRST FLOOR SQ FTG 336.00 Permit . . . . . . BUILDING PERMIT Additional desc.. Permit Fee . . . . .2.07.00 Plan.Check Fee 134.55 Issue Date Valuation .. . 19600 Qty Unit Charge Per, Extension BASE FEE 45.00 18.00 9.0000 THOU BLDG 2,001-25,-000 162.00 ---------------------------- Permit . . . . ---------=-------------------------------------- ELECT -':ADD/ALT/REM Additional desc Permit Fee 26.76 Plan Check Fee 6.69 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 336.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 11.76 P.O. Box 1504 VOICE -(7-60) 777-7017 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760)'777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: Date: Architect or Engineer: Architect or Engineer'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 9 (commencing with Section 7000) of Division 3 of the Business and Professionals 'Code, and my Licensg is in full force and effect. t 9r 1 License Class (a' / L License No. ` 6 Date 9C Contractor OWNER -BUILDER DECLARATION I hereby affirmunder penalty of 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 permit to file 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 a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 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 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 I, as owner of the property, am exclusively contracting with licensed contractors to constrict 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. BA P.C. for this reason Date Owner WORKERS' 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 ,i�sued�y wof%compensation insurance carrier and policy number are: Cartier C> i( h1 l Policy Number _ I certify that, in the performance of the work for which thispermit is issued, I 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 shall forthwith comply with those provisiions./. Date 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. CONSTRUCTION LENDING AGENCY hereby affirm under penalty of perjury that there is a construction lending agency for the.perfornance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address 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 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 upon the above-mentioned property for inspection purposes. Date Signature (Applicant or Agent):Lai�/ Page 2 Application Number . . . . . 04-00005305 Date 7/01/04 Permit . . . . . MECHANICAL Additional desc Permit Fee . . . . 48.50 Plan Check Fee 12.13 Issue Date . . . . Valuation 0 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 APPL REP/ALT/ADD 9.00 1.00 9.0000 EA' MECH B/C <=3HP/100K BTU 9.00 1.00 6.5000 EA MECH VENT FAN 6.50 ----------------------------------=----------------------------------------- Permit . . . . . . PLUMBING Additional desc . . Permit Fee . . 36.00 Plan Check Fee 9.00 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 6.0000 EA PLB FIXTURE 18.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 ----------------------------------------------------------- ---------------- Special Notes and Comments CONVERT GARAGE TO BEDROOM AND ADD BATHROOM. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 13.46 STRONG MOTION (SMI) - RES 1.96 Fee summary Charged Paid Credited Due ----------------- ---------- --- ------ ---------- ---------- Permit Fee Total 318.26 .00 .00 318.26 Plan Check Total 162.37 .00 .00 162.37 Other Fee Total 15.42 .00 .00 15.42 Grand Total 496.05 .00 .00 496.05