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05-1524 (AR)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: Property Address: APN: Application description Property Zoning: Applicatial CO -5 00001524' 46414—ROUDELrLN 649-052-004-27 -2667 ADDITION - RESIDENTIAL LOW DENSITY RESIDENTIAL 1982 Owner: DENISE GOOCH 46-414 ROUDEL LANE LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/09/05 Contractor: npplicant:Architect or Engineer: RIMA CONSTRUCTION 8720 VILLA LA JOLLA DRIVE #115 LA JOLLA, CA 92037 (619)316-4459 Lic. No.: 808398 -------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION -WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B License No.: 808398 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Date: Contractor: 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 issued. My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: hereby affirm under. penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EXEMPT Policy Number . EXEMPT following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to - -"I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Lab or� e, I shall forthwih ply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption: Any violation of Section 7031.5 by 1 (/[/I,, any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: _Oatei �.ircppiicant: com \ N !_,/C/ m (_ 1 I, as owner of the property, or my employees with wages as their sale compensation, will do the work, and — — I— ---^ -' ' the structure is not intended or offered for sale (Sec. 7044, Business and ProfessionsCode: The WARN G: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO,CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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, 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 prnrurrtr whn hitilds nr imnrnves therenn and whin nnntrants fnr the. nmiects with a ggrltra0gr(S) Ilcemod pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. , B.&P.C. for this reason . ' Date: 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: LQPERMIT 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'perrint issued at a MSUlt oT IMIS applIcatlon, the owner, and the applicant, each agrees to, and shall 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 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 county to enter upon pe above-mentioned pro y inspection pur ss'es. Date: -4 g�ature (Applicant or Agent): Application Number . . . 05-00001524 Permit . . . BUILDING PERMIT Additional desc Permit Fee . . 45.00 Plan Check Fee 64.25 Issue Date . . . . Valuation . . . . 1982 Expiration Date 12/06/05 Qty Unit Charge Per Extension BASE FEE 15-00 15.00• 2.0000 HIVID BLDG 501-2,000 30.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee- 16.50 Plan Check Fee 4.13 Issue Date . . . Valuation 0 Expiration Date 12/06/05 Qty Unit Charge Per Extension BASE FEE 15.00 .00 .0350 ELEC NEW RES - 1 OR 2 FAMILY .00 00 .0200 ELEC GARAGE OR NON-RESIDENTIAL .00 2.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 1.5"0" Special Notes and Comments ADDITION - 11FT X 13.5 FT (149 sq.ft.)SUNROOM AT•MASTER BEDROOM. TYPE V -N CONSTRUCTION, 2001 CODES.. **FIELD VERIFY SMOKE DETECTOR IN REQUIRED AREAS**" -------------------------- Other Fees . . . . . ------------------------------------------------- . . . . ENERGY REVIEW FEE 6.43 STRONG MOTION (SMI) - RES. .50 Fee summary., Charged Paid Credited Due Permit Fee Total 61.50 .00 .00 61.50 Plan Check Total 68.38 .00 .00 68.38 Other.Fee`Total 6.93 .00 .00 .6.93. Grand Total 136.81 .00 .00 136•.81 LQPERMIT Bin # City of L Qutnl.C>I \� Building 8t Safety Division ' P.O. Box 1504, 78-495 Calle Tampico La Quirita, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: L 1 - QD V 1 L -n LG t9v., Owner's Name: � S e, n 60 CAn A. P. Number: �p !� D 50� 00 Address: � a I Legal Description: c City,.ST, Zip: CA %SAddContractor•' Telephone: , - Address: ress: Project Description: 0N C4,3 W1 City, ST, Zip: 0 ele h e. Telephone: Po 3 w State Lic. # : g % Dy- Arch., Ems, Designer: City Lic. #: S Address: r✓- 2 City, ST, Zip: Iseb kCUAA_ hone: S Lic. #: .Tele .State .ProjecthPe rut Construction Uon T e: O�cu ant Y•- Y P P (circle one. New Alter Repair Demo Name of Contact Person: Sq. Ft.: l #. Stories: )l # Units: , Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # _ Submittal Req'd Rec'd TRACKING 8'� PERMIT FEES Plan Sets Plan Check submitted tem Amount Structural Calcs. a Reviewed, ready for corrections Plan Check deposit Truss Calcs. Called Contact Person Plan Check Balance .Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical: Grading plan 2nd Review, ready for correc�tlion ssu % O Electrical Subcontactor List Called Contact Person Wil" Plumbing Grant Deed Plans picked up I M S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review, ready for corrections/issue Developer Impact Fee f Planning Approval Called Contact Person A.I.P.P. :Y 7 Pub. Wks. Appr Date of permit issue School Fees Total Perrot Fees 13UQ, J/Y,IsY, lY � Itl Vert Gl j 4T 444 . 4 jig � �� Vf �!✓/J] � � bpi �' ,Y , • ' . ,:. .. - , cal. n,7 �' r 1 •,S• T --=� �- • '`,tom"" � -C,,.:-.�;,.,:-� ' ' s .. IA gTy g with"the`200I California ' f� - - --'/ i '-I— hall , construction scomp y Plumbing, Mechanical, _Iectrvca, and Energy Building, _ Codes and all other local codes and ordinances.° ;3