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04-4899 (RER).J ` °F �wQur«rw BUILDING & SAFETY DEPARTMENT P.O. Box 1504. (760) 777-.7012 78-495 CALLE TAMPIC.o FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760).777-7153° BUILDING PERMIT Application Number . . i . Pr.operty Address APN Application description Property Zoning Application valuation Owner WILLIAMS HOWARD ANDREW.. .-C/O. ROSENFELD'.MEYER & SUSMAN' 9602 WILSH.IRE BLV 4TH FL BEVERLY HIL .: �CX :90210 04-00004899 04' _ 9035 CEDROS� CIR._ , 646-210-009- - - .REMODEL - RESIDENTIAL LOW DENSITY RESIDENTIAL 25000 Date. 10/18/04 Contractor . DOLAN CONSTRUCTION; J.A.: 7.4040 HIGHWAY 111- STE #L=2.07 PALM .DESERT .:. :'CA :92260 (760) .34.0;-0905 = a� WCC ::. STATE.:FUND �..WC-: 229002'0047 ; 01//05 01 l%+ C$LB.: ' . 645369 05/31/06 n�t1NiA CCC : B ------ Structure Informat i %V RA`•ISE:pR0-OF—LINE - - - - - Construction. Type _ .FtM �4TYPE. V - NON RATED .Occupancy Type DWELLG/LODGING/LONG <=10 Flood Zone NON-AO.FLOOD ZONE. Other struct info CODE EDITION 2001 Permit...BUILDING .PERMIT . Additional. desc .. Permit .Fee 2:52.,001Plan Check .Fee" 163.8.0 Issue'Date Val.uation: 25000 Qty Unit Charge Per Extension. BASE FEE .45-.00 23 . ao 9:0000 THOU . BLDG: 2.,-0-0 1- 2 5, 000 2.0.7 .'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 MECHANICAE" Additional desc Permit Fee " 15.00 Pl'an..Check Fee 3.75 Issue.Date Valuation 0 Qty Unit Charge. Per Extension BASE FEE 15.00 P.O. BOX 1504 • '�C�� 78-495 CALLE TAMrlco LA QUINTA, CALIFORNIA 922.53 BUILDING & SAFETY DEPARTMENT Application Number: o y Applicant: Applicant's tin A dre s: Architect or Engineer:: VOICE°(:760) 777. -791 -2 - PAX (760) 777-7011 INSPECTIONS (76,0)'777-71.53 FFOIFAK� 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 a (ooryvnencing with Section 7000) of Division 3 of the Business and Professionals :;Code, andmy License is full force and effect License Class iS /t l[, License No. Date v 20 G Contractor o� - 03 06-t1 T - 6 , OWNER -BUILDER DECLARATION I hereby affirm*under penalty of perjury that I am exempt from the Contractors'. State License Law for the followir►g reason (Sec. 7031.5, Business and Professions Code: Any th city or county at requires a permit to construct, atter, improve, demolish, or repair any structure; prior to its issuance, also requires the applicant for thepermit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractus' Stare 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.ft alleged exemption. Any violation of section 7031.5 by any applicant for a permit subjects the appficant.to a civil penalty of not more than five hundred dollars ($500).): U 1, 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 budding 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 [mprove.for the purpose of sale.). U 1. as owner of the property, am exclusively contracting with licensed contractors to constrict this project (Sec. 7044, Business and Professions Code: The Contractors' State. License:law does not apply to an owner of property who builds or improves ttmereon,'and who contracts for the projects with a contractor(s) kargd pursuant to the Contractors' State License Law.). U I am exempt under Sec ..B.& 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 self4nsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for #* performance of the work for which this permit is issued . _ I have and will maintain workers' comipensation Insurance, as required by Section 3700 of the Labor Code, for the perfomnahce of the work for wNch this permit is issued. ti ens' compensation Insurance carrier and policy nurnber are: Carder Ci 7L4'st; c!J Poficy Number Z2.�i r OZ ttSQ >f `l . _ I oxtify:ihat, in the performance of the work for which thus pemnit Is Issued, I shah nil employ any person in any marxter so as to become subject to the workers' cornpensation laws of Cardomj .arida It.ot, if I should become subject to the workere•. compensation provisions of Section 3700 of the Labor Code. I shall forthwith comply with those Ii KK WARNING: FAILURE TO SECURE WO f"RS' COMPENSATION COVERAGE IS UNLAWFUL", AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL" PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TI�OUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the.performance of the wok for which this permit is issued (Sea 3097, Civ. C.). Lenders Name Lenders 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 issued as a result of thus a ication, Bre owner, and the applicant, each hold harmed under it pursuant to any permit ppm pp agrees to, and shah, defend, indemnify and hold harmless the City of La Quintic, 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 rat commenced within 180 days from date of Issuance of such permit, or cessation of work for 180 days will subject pemmlt to cancellation. I certify that 1 have read this application and state that the above information is correct. 1 agree to comply with an city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to ter u hti^e above-mentioned property for inspection purposes. Date - 2d Signature (Applicant or Agent): 0 Page 2 Application Number . . . . . 04-00004899 Date 10/18/04 ---------------------------------------------------------------------------- Special Notes and Comments raise roof line 34 inches and add 10 ft. dual glazed sliders 10/18/04 1:47:33 PM jjohnson ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 16.38 Fee summary Charged Paid Credited Due Permit Fee Total 282.00 .00 .00 282.00 Plan .Check Total 171.30 .00 .00 171.30 Other Fee Total 16.38 .00 .00 16.38 Grand Total 469.68 .00 .00 469.68