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04-5851 (AR)BUILDING &SAFETY DEPARTMENT ci°�t9 7 5 . pso (.760)' 777-.7012 OF FAX (760) 777-701't L Q Im ORNIA 92253 INSPECTION REQUESTS (760).777-7153 BUILDING PERMIT Application Number 04-00005851 Date 10/19/04 Property Address 78045 CALLE CADIZ APN:770-153-004- - - Application description ADDITION.- RESIDENTIAL Property Zoning VILLAGE COMMERCIAL Application valuation 4500 Contra: --r-----------------------------'-- LA QVINTA_GRILL. C & G CONSTRUCTION -COMPANY- -41.86.5 ;BOARDWALK NO 214 9.65 N. ;2ND„STREET ,2�„.. PALM•y,DE;S.ERT :: -... ..• ...t"CA 92211 UPLAND... CA :9'1'786 WCC.. STATE FUND . WC':: •.1799:2-67... 10%01/05 CSLB ::. 6.92234 7 07:/.31/06 B .-- ---. Structure Information ADD KING POST AND FTS. -.---- Construction Type . . . TYPE V.- NON :RATED. Occupancy Type BUSINESS <50 Flood Zone NON -AO FLOOD.ZONE Other struct info CODE EDITION 2001 CBC FLOOD: ZONE NO VPermit . BUILDING .PERMIT . 'Addit:ional desc , Permit:: Feo :72 .-007 -Plan' Check` •Fee- 46'.;8.0 Issue. Date : :Valuat°ion: 4500 Qty., Unit Charge Per Extension. ° BASE .FEE 45.00 3 '0,0 9.: 0:000 ,THOU:. BLDG: 2., 001-25, 000 ..2.7.'00 Permit ELECT ADD/ALT/REM Additional desc Permit -Fee 15.00' Plan Check Fee 3:75 Issue Date ,. Valuation 0 Qty Unit Charge. Per Extension BASE. FEE. 15.00. ----------------------------------------------------------------------------- Permit MECHANICAL" Additional desc Permit Fee 15..00. Plan. Check Fee 3.75 Issue.Date Valuation 0 Qty. Unit Charge Per Extension BASE FEE 15.00 P.O. BOX 1504 QuArcu VOICE-(7-60)777=76T2 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (76.0)'777-71.53 BUILDING & SAFETY DEPARTMENT Application Number:. Date: 0 Applicant: Architect or Engineer:: �o NT i'2/ir C17 -0R . Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (comxnendng with Section 7000) of Division 3 of the Business and Professionals 'Code, and my License is in full force and effect. License Class Ucense No: Date 4 20 0`-' Contractor OWNER -BUILDER DECLARATION I hereby afrum'under penalty of perjury that 1 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 struckm 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 pemut subjects the applicant to a dA penally of not more than five hundred dollars (M).) 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 Piofessiois 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. H, however, the budding or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he oushe did not build or Improve for the purpose of sale.). U I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Sea 7144, Business and Professions Code: The Con"Oors' State. License: Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contactor(s) ficensed pursuant to the Contractors` State License Law.). (, I am exempt under Sec. ..B.& P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations:. i I have and will maintain a certificate of consent to self4nsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this pemdt 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 pemwt is Issued. My workers' conmpensation insurance prier and'PP�olicy n r a Carrier GjTR'`� FV Titer Forney Number O 4-4 1 certify:that, in the peRormance of the work for which this: permit Is issued, I shah not employ any person In any manner so as to become subject lo the workers' compensation laws of California. and agree that, if I should become subject to the workere compensation provisions of Section 3700 of the Labor Code. l shag forthwith comply with those provisions. Date !4' -1P db Appruanf tai �� S-P2-L�GTt 0 i� 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 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury Ihat #here Is a construction lending agency for the _performance of the work for which this permit is issued (Sea 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.behali 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 shag, 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 followinq issuance of this pemrk 2. Any permit Issued as a result of this application becomes null and void It work is rat comirnenced within 180 days from data of issuance of such pemnk or cessation of work for 180 days will subject permit to cancellation. 1 certify that 1 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 `T ZO' O J Signature (Applicant or Agent): ►— `'� �� Page 2 Application Number . . . . . 04-00005851 Date 10/19/04 ---------------------------------------------------------------------------- Special Notes and Comments` ADD KING POST ON TOP OF CEILING .JOIST,INTRODUSE FOOTING & POST.10/19/04. ,6:25:59 AM jjohnson ---------------------------------------------------------------------------- Other Fees STRONG MOTION (SMI) - RES .50 Fee summary Charged Paid Credited Due Permit Fee Total 102.00. .00 .00 102.00 Plan Check Total 54.30 .00 .00 54.30 Other Fee Total .50 .00 .00 .50 Grand Total 156.80 .00 .00, 156.80 'CL56—?Zl (AO6) SNDISICI 319YO11M ?14.k— -"Z' 'J31N3d'dV3 'a 13YH:)IW w . . 'nlVD'Y:Lmnm Yi 7 6;40/ Z: OFFICEWI*40 (OPV Ll it 7 6;40/ Z: OFFICEWI*40 (OPV