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05-1095 (AR))k P.O. BOX 1504 , 78495 CALLE TAMPICO LA QUINTA, CALIFORNIA. 92253 a 4r;:0 ffX . � .. =1f 11 14 rM BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/18/05 Application Number: 05-00001095 Owner: Property Address: 49155 CASA DEL RIO JILL PRICE APN: 646-330-049- - - 49-155 CASA DEL RIO Application description: ADDITION - RESIDENTIAL LA QUINTA, CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 13785 Contractor: Applicant: p itect or Engineer: BAESKENS CONSTRUCTION INC O 18498 DAMON DRIVE HESPERIA, CA 92345 1 6 (760)244-0371 Lic. No.: 481844 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'Divis)ore3 of the Business and P.rofeasionals Code, and my license is in full force and effect. License Gass: C36 Lioense No.: 483844 Date: Contractor: OWNER -BUILDER DECLARATION 1 hereby affirm under penalty of perjury thatl.am exempt from the Contractor's State Lioense-Law'forthe following reason (Sec. 7031,.5,. Business and Professions Code: Anycity 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 fora permit subjects the applicantto a civil penalty of not more than five hundred dollars (8500):: (_) 1, as owner'of the property,•or my employees with wages as their sole compensation, will do the work, and the structure isnot intended or offered for sale(Sec. 7044, Business and Professions Code: The Contractors' State License,LawAoes 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 1 I, as,owner of thwpioperty, 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,3. 1 _) I arri exempt under Sec. ,.B.&PDQ-TOr tKis reason Date: Owner: ONS CTION LENDING AGENCY Thereby affirm under penalty of perjury that thlireconstruction lending agency for the performance of the work for which this permit Is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQP&RMIT WORKER'S COMPENSATION DECLARATION I hereby affirm under penatty, of perjury'" of the following declarations: _ I. have and will maintain a certificate of,consem to self -insure for workers' compensation, as provided for by Section 3700 of the, he Labor Code, for theperformance of the work for which this permit is issued. _ Ihave'and willmaintain workers' compensation insurance,.as:required by Section 3700 of the Labor Code, forthe performance of the workifor•which this, permit is issued.. My workers' compensation insurance carrier and policy number are. Carrier STATE ' FUND Policy Number_ 1195236 1 certify that, in the. performance of the work for which this permit 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 1 sh(pd become subject to the workepr'-compensation provisions of Section 3790 of the r II fo ply with oae,provisions. Date: pitta WARNING: FAILURE TO SEC E W KERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO RIMI AL,KkALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($ 100,000)., IN AD N 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 made4o.the Director of Building and Safety fora permitsubject 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 0uima, its officers, agents:andiemployees for any act or omission related to the work being performed under or following issuance of thWpermit. 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 bo rhe information is torr res to comply with all city and county ordinances and state laws.rslating to ildi natru 'on,.a reby out rize comply atives of this.coun to e , r upon the above-mentioned pr party for 'us Date: nature (Applicant or Agent) Application Number . . . 05-00001095 ------ Structure Information 241 SQ. FT. ADD / REM. ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . DWELLG/LODGING/CONE <=10 Flood Zone . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION .2001 CBC FLOOD ZONE NO 1ST FLOOR•SQUARE FOOTAGE 241..00 Permit.BUILDING PERMIT Add3. tion'aldesc.. . Permit Fee 153.00 Plan Check Fee 99.45 Issue Date . . . Valuation . . . . 13785 Expiration'Date 11/14/05 Qty Unit Charge Per Extension - BASE FEE 45.00 12.00 9.0000 .THOU BLDG 2,0.01-25,000 108.00 Permit. . . . ELECT - ADD/ALT/REM Additional desc . Permit.Fee . . . . 23.44 Plan Check Fee 5.86 Issue Date. Valuation . . . . 0 Expiration Date 11/14_/05 Qty Unit Charge Per Extension BASE FEE 15.00 241.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 8.44 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 2.4.00 Plan Check Fee 6.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/14/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA •MECH APPL REP/ALT/ADD 9.00 - -------- - -- - - - - - - - - - - -- ----- Special Notes and Comments 241 SQ. FT. REMODEL & ADDITION -------------------_--- ------ - -- Other Fees . . . . . . . ENERGY REVIEW FEE 9.95 STRONG.MOTION (SMI) - RES 1.37 Fee summary Charged Paid Credited Due, WrERMrr Application Number Permit Fee Total 200.44 Plan Check Total 111.31 Other Fee Total 11.32 Grand Total 323.07 LQPESMIT 05-0000:1095 .00 .00 200.44 .00 .0.0 111.31 .00 .00 11.32 .00 .00 323.07.