04-5833 (RER)78-4
.L . • F
lw
? :I= BUILDING14 SAFETY DEPARTMENT
1504.
f �. (760)'777.7012 .
,
ULE -TAMPIC.O
"x * ',FAX (760) 777-7011
A,'CALIFORNiA 92253 INSPECTION, REQUESTS. (760).777-71.53
BUILDING,.PERMIT
, , • ,-�;
-Application Number
rO4-00005833 Date.. 10/05/04
Property Address
73AL
CLE�PALOMAjW
APN: ..
..505
770"096`004 ;76 p 000'0&0-
Applicat on descr pt on"<;: -'REMODELS .$i-RESIDENTIAL'--"�
Property- Zonings
'`.LOW :RESIDENTIAL
Application-valuation
{DENSITY
i+12000,r`.^6.�.
Owner
F�
" Contractor
— — — — — — — — — - — — — —— — — —`M4J*.aJr`!-,�s��..�...
BILL.BRADDOCK,-.
SMITH GENERAL'_CNTR,.PAUL
ALLEN
50-7..35 CALLS PALOMA
- f` ,tet , 820 RESEARCHa DRIVE,
#5
LA QUINTA ...CA 922:53. .,PPLM;$PRINGS
• •CA.9262 ."
19
�760')s`325 X77
-{ s WCC -,:i.,[. {n EXEMPT .
rt , WC'- "EXEMPT
03/31/05
y, 1'
! r,G:,' •.CSLB�' 2.85295'
:07,x:31/06
'. RJ\'. _... .. .•
•, ` CCC B_"-C10.x^•".
.. ...' ,
- - Structure Information.
-Construction
�'
'.630 SQ 'y FT J�iPATIO,-BBQ",SINKS , '3
HEATERSm-
Type
: TYPE,V-•.,.'='
Occupancy Type
-DWELL- LODGING'%GONG'
Flood Zone
NON, AO' FLO.OD�ZONEt
Other struct info
- CODE EpITION." T 2:0:07
r . : ,,. :r . a„ Vit; t�.: .;'
---------------
- - - - - -
_ _
---- . -
.Permit - - . -----
• .: "'
_
ELIC MI SCELLANEOUSia''
1'-
- . Additional. -desc
Permit Fee
27 0,0,Plan. Cheek, Fee
6 . 75.
Issue Date
..Valuation "'
0
Qty` Unit Charge
Per, l.:��
Extension
BASE' FEE�� .�,�
' 15.00.
16'.00. ..7500
.'' ELECDEVICE/FIXTURE.-.lST""'20
1-2`..00
.PER
i ,• y
Permit'f •'
_ _
MECHANICAL'
Addit-ional desc
"' w
Permit Fee
51,.'0 0 Plan",Chock' Fee
12 75
Issue Date
" '� !,,Valuat'ion
.Qty Unit Charge
Per y �"` ""`=' °`�
Extension
BAS'S , s
15 0 0
4. 00:..: `9 . 0 0 0 0
.. EA �MECH SUS P /WP,LL; HEATER ,
36,00
------------------ ---
Permit
v--.�,�----- ----- -� ---------.------------.
PATIO.'COVER`APERMIT ��'� ' " ;x `t '
`k(..
t. . ";�' •! ak
Additional desc �.
: tom: •. „+ i"'i�.S r}y n ,,•f' 4. °•
;4 ,�*trst;_ •;#=k
- .
Permit .Fee
~l35 "0-0 ` ` Plah' ,-hDek' Fee
8.7.. 75
t ..
P.O. Box 1504 •
78-495 CALLE TAMPICO
LA QUiNTA, CALIFORNIA 92253 .414 QUIArej
BUILDING & SAFETY DEPARTMENT
Application Number: Cl
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
VOICE"(:760) 777-7072
FAX (760) 777-7011
INSPECTIONS (760)'777-7153
Date: %0 -/2-o
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under enalty of perjury that I am licensed under provisions 9 (�ng with Section 7000) of Division 3 of the Business and Professionals
Code, arm d ed S
l icer License No.
Datett LI), d + Contrado �a Yl e11 fA
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contradors': 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 strucdxe,'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 cMl 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, wig 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 tD 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 lir the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contraptors' '
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) liicensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. _.BA 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 setf4nsure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued. .
_ I ha4 and will maintain workers' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for *filch this permit Is
ed. My workers' compensation insurance carrier and policy number are:
Carrier Policy Number
_ I certifyAriat, in the performance of the work for which thispenrit Is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Cardbmi and agree thiat, N I should become subject to the workers': compensation provisions of Section 3700 of the Labor Code, I shad
Ay=
y with those ons.
DateApp fican U_
6
WARNING: FALRE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFU', 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 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 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 per -it 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 wok Is not commenced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit t ation.
I certify that I have read this application and state that the Ftion is correct I to with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this r up a boned for n purposes.
Date Signature (Applicant or Agen
k
. Page_
2
Application ,Number
04-00V0583'3.'^ Date._
10/05/04
Issue Date
Valuat'•on
12000
Qty Unit•Charge
Per
Extension
BASE FEE
45.00
10.00 9.0000
THOU BLDG 2,001=25.,,.0'00
90.00
Permit . . . . .
PLUMBING
Additional desc
Permit Fee
33.75 "r ',P1an,Check Fee
8.44
Issue Date
'Valuation
0
Qty Unit Charge.
Per
Extension
BASE! FEE
1'5.00
2.00 6.0000
EA PLB.FIXTURE. `:
12.00
1.00 3.0000
EA PLB"WATER INST/ALT'/REP,
3.00
5.,00.. 75`00
'EA PLB GAS PLPE > 54;-::
3 .75 .
,_:__-_
'Special Notes and, -Comments
630 SQ.,,FT.PAT I0 ;A•DDITION.
WITH BBQ,
SINKS AND HEATERS' =10/5/•04
11:04:17.:AM
JJOHNSON
Other Fees
-------------------------
STRONG ;MOTION `- ('SMI) ' - 'RES.
1.2b
Fee.summary Charged
Paid. Credited
Due..
Permit Fee Total.
246.75 .00'.- .00
246.75
Plan Check Total
175.69 3 :.00--- - .00
115.69
Other.Fee Total.
1.20, 00`•-, :00.
1.20
Grand Total
363.64 .00 .00
363.64.
I 7f
; %. .. CIQuino,
.:
9 t)/ Of La
Building & Safety. Division'
Permit # P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
J� Poject Address:
e.LHA OwnName:Ak L
AP.
Number Address: ��_ �,
S � cw L� ►-�- A
Legal Description: City, ST. Zip: L z D S3
X ContractorV k&_ ITO11. JM VC
FTelephone: 3 3� ` •'�'� ��`
:Address:�liD r . �!, • t�..- . aa.
t��- Project Description• . Lb
X City, ST, Zip: . �-. ool o ZL� 2,—
F*
X Telephone: 3'li�..�` `
4.
X state Lie. # : 3 �y
City Lic. #D ,
Arch.. Engr» Designer .
Address: `i
City. ST, Zip: c�
Telephone: ::-
.L Construction Type: Occupancy:
State Lic. #: e^ft
-�7/�FrQjcct New Add'n Alter Repair Demo
X Name of Contact Person: ' C '-�-w" `ec ,
�#
Sq. t : 9Stories:. # Units: -
%i Telephone # of Contact Person: g' 3 t7_ ated Value of Project:. Ti a
APPLICANT: DO NOT WRITE. BELOW THIS LINE
M Submittal Req`d Ra'd TRACKING
3PERMIT FEES
Pisa Sets Plan Check submitied . 8
Structural talcs.
A!* wed xeady,f .eomctio Item Aurount
!� Plan Cheek DeposiC
?rtes Glee. tiled Contact P $I�
Plea Check Balance
Energy Gla. Plans licked up
Construction.'
Flood plain plan ' Plansranbaiitted
ahaaical
Grading plan Y' Review; ready -for correctioasricsue `
Electrical
Subcontaetor List Called Contact Person .
Plumbing
Grant Deed • Plans picked up
S.M.I.
H.O.A. Approval Plans resubmitted
Grading
IN HOUSE:. ''' Review, ready for comissue
ctio evel r Impact Fee
Planning Approval Called Contact Person
.f.P.P.
Pub. Wks. Appr Date of permit issue
School Fees
Total Permit Fees