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04-5067 (AR)T44f 4 4 Q" .. I BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 04-00005067 Property Address . . . 78999 CARMEL CIR APN: 646 -400 -034 - Application description ADDITION - RESIDENTI. Property Zoning . . . . . . . LOW DENSITY RESIDENT Application valuation . . . . 99219 Owner METTLER JOHN H C/O CIRCUIT WISE INC 400 SACKETT PT RD NORTH HAVEN CT 6423 8/30/04 A-A...., s . AUG 3 01004 CITY _OF LA QUINre Contractor ------------------------ CLARK JR GEN CONTR, JACK 51220 AVENIDA CARRANZA LA QUINTA CA 92253 (760) 564-3511 WCC: EXEMPT WC: EXEMPT 03/04/05 CSLB: 506667 03/31/05 CCC: B ------ Structure Information 1174 SQ. FT. CASITA ADDITION ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . DWELLG/LODGING/LONG <=10 Flood Zone . . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC FLOOD ZONE NO GARAGE SQ FTG 27.,_00 PATIO SQ FTG 288.00 FIRST FLOOR SQ FTG 1174.00 ------------------------------------------------ --------------------------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee 639.50 Plan Check Fee 415.68 Issue Date Valuation . . . . 99219 Qty Unit Charge Per Extension BASE FEE 414.50 50.00 4.5000 THOU BLDG 50,001-100,000 225.00 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL Additional desc Permit'Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date Valuation 0 Qty Unit Charge Per I Extension BASE FEE 15..00 a P.O. Box 1504•4 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Og 5c* 7 Date: 3 D - O Applicant: I Architect or Engineer: 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 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. / nse Class 12 icense No. 5�6b 7 OWNER -BUILDER DECLARATION I hereby affirm under 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 1, 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(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date WORKERS' COMPENSATION DECLARATION I hereby,a vm under penalty of perl'ury one of the following declarations: 14 1 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 pennit is issued. have and will maintain workers' compens�Oon insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is d. My worker ' compensation ' rence carrier and policy number are: r/�/j� —( 91icv Number I certify that, i 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 I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall `forthwith comply with those provisions. pliant (�iQiC�L 4f 14444 Z 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 I 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 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 ent/er/upon the above-mentioned property for inspection purposes. ate �I 3( �•� Si ure (Applicant or Agent): ��`� i;1 Page 2 Application Number .. . . . . 04-00005067 Date 8/30/04 Qty Unit Charge Per Extension 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 -------------------------- Permit . . . . . . -------------------------------------------------- ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 56.63 Plan Check Fee 14.16 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00' 1174.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 41.09 27.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL .54 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc . . Permit Fee . . . . 54.00 Plan Check Fee 13.50 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 3.00 6.0000 EA PLB ROOF DRAIN 18.00- 8.001.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Permit . . . . . . GRADING PERMIT Additional desc . . Permit Fee . . . . 15.0.0 Plan Check Fee .00 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments 1174 SQ. FT. CASITA ADDITION. ---------------------------------------------------------------------------- Other Fees . . . . . . . . ENERGY REVIEW FEE 41.57 STRONG MOTION (SMI) - RES 9.92 Fee summary Charged Paid Credited Due I I I I - t Il 1 ' 1 Application Number . . . 04-00005067 Permit Fee Total 798.13 .00 ..00 Plan Check Total 451.59 .00 .00 Other Fee Total 51.49 .00 .00 Grand Total 1301.21 .00 .00 { I i Page 3 Date 8/30/04 798.13 451.59 51.49 1301.21