05-4761 (RER)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:
Application valuation:
Applicant:
Y
0
05-00004761
78230 SAN TIMOTEO ST
646-160-017- -
REMODEL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
20000
Architect or
Owner:
BALL STERLING C
6886 OCUITT RD
SAN LUIS OBISPO, CA 93401
Contractor:
SIPOVAC CONSTRUCTION, ,INC
72651 THOEDORA LANE
PALM DESERT, CA 92260
(760)809-7538
Lic. No.: 581636•
VOICE (760) 777-7012
..FAX (760) 777-1011
INSPECTIONS (760) 777-7153
Date: 12/14/05
------------------------------------------------
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 Licen a No.: 581636
for by Section 3700 of the Labor Code; for the performance of the work for which this permit is
issued.
ate: tractor: �� - —
_ (.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:
I 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
_
_ 1 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' compe atior provisions of Section
-•o
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
m
0 of the Labor Code, I shall forthwith coply with, a pr is ions.
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).:
3.0
.
/licantJ
Date: Z d Of IC p�p: _ _ -
(_ 1 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
WARNING: 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.).
(_ I 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.).
(_ I I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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:
LQPERA1IT
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 agre�reoe.entatives mply with all
city and county ordinances and state laws relating to building construction, hereby author'
of th�nt to ent upon the above-mentioned property f spectioft' r ses. t
atur�licant or Agent)' ��
LQPERAIIT
Application'•Number 05-00004761
Permit BUILDING PERMIT
Additional desc .
Permit Fee . . . 207.00 Plan Check
Fee
134.55
Issue Date . . . . Valuation
20000
Expiration Date 6/12/06
Qty Unit -Charge Per
Extension
BASE FEE
45.00
18'.00 9.0000 THOU BLDG 2,001-25,000
-------------------------------------------------------------------------
162.00
Permit ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . . 20.25 Plan Check
Fee
5.06 .
Issue Date . . Valuation
0 .
Expiration Date 6/12/06
Qty Unit Charge Per
Extension
BASE FEE-
15.00
7.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
5.25
---------------------------------------------------------------------------
Special Notes and Comments
i
NEW ENTRY PORTICO 76 SF, RELOCATE
GARAGE DOORS.2001 CBC,CMC,CPC,
.2.004
CEC, 2005 ENERGY CODES.
NOTE: PLANCHECK BALANCE.OF 104.45 FROM
WITHDRAWN APPLICATION 05-0038 IS
CHARGED TO THIS PERMIT.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENERGY REVIEW FEE
13.46
HOURLY PLAN CHECK
104.45.
STRONG MOTION (SMI)
- RES
2.00'.
Fee summary Charged. Paid Credited
Due
Permit Fee Total 227.25 .00
.00
227.25
Plan Check Total 139.61 00
00
139.61
Other Fee Total 119.91 .00
.00
119.91
Grand Total 486.77. .00
.00
486.77
Bin #
�./
J '
City of La Quinta
Building & Safety Division
Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # tXJP.O.
Project Address: "79r 2 30 7d e-1-1,04fet)
Owner's Name: /47
A. P. Number:
Address: 712 30 Jit A T � o'feo
Legal Description:
City, ST, Zip: (� Q�/�� fi4 CA 92 2S3
•+�- - .
Telephone: : t �..`
Project Description: /e/Qinq to Q e 4t
%7Q G Dtf „/ bew J�
Contractor:�
e yy,iae�
Address:
City, ST, Zip:
Telephone:
State Lic. # : City Lic. #:
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!! �� to oz -
Arch., Engr., Designer: Cu ot(j Sh v e 4, l ,
�'��?
'par
7�
e
Address: 79,?h F`a l t/Qv-fA i•
City, ST, Zip:) Ve. je, t 1 ZZ410
Telephone: 76Q N 73 SY
Cl8 �- �:.�- � ��
State Lic. #: 3
Name of Contact Person: CG V e
Construction Type: hAOccupancy:
Project type (circle one): New Add'nAlte Repair Demo
Sq. Ft.:
#Stories:
#Units:
'' //
Telephone # of Contact Person: 3 — 7 3 S5/
T
Estimated Value of Project: 2a, 400 , 00
APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'd
::: TRACKING
PERMIT FEES
Plan Sets
a
Plan Check submitted 10/.u/Item
Amount
Structural Calcs.
Reviewed, ready for corrections 11/9>
Plan Check Deposit
Truss Calcs.
Called Contact Person 4/4t)
Plan Check Balance
•
Energy Calcs.Plans
picked up /�
Construction
•
Flood plain planPlans
resubmitted �� P,
Mechanical
Grading plan
2"d Review, ready for corrections/issue
Electrical
0
Subcontactor List
Called Contact Person 1-o
Plumbing
GrantDced
Plans picked up w� S + �
'S•M.I.
H.O.A. Approval
Plans resubmitted '�
Grading
IN HOUSE:-
''" Review, ready for corrections/issue IL
Developer Impact Fee
Planning Approval
Called Contact Person XI -6tiM
A.I.P.P.
Pub. Wks. Appr
School Fees
Date of permit issue Q 0
e
�� Ol/•�N%N ��
/,e�(�
!!
Total Permit Fees
I0/ay .5tuax—, ---:P
cp/LV 7L�, - ,� I I• C4. V a
(L/} fT�-.�/ �4rlc /LFC
217 Nor 56T- To &Nz ��T �NG�•se ��