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04-6124 (AR)c� r T4&f 4 4auk fw /4 BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7012 DF Tt � -7`8- 495yCALLE TAMPICO �. FAX (760) 777-7011 �LA-QU'INT�A, D d CALIFORNIA 92253 ' INSPECTION REQUESTS (760) 777-7153 N� BUILDING PERMIT ziuvY/"i y Address . . . . . APN: Application description Property Zoning . . . . Application valuation . --04-00006124___ Date 9/09/04 45235 COLDBROOK LN 604-413-002-11 -23995 ADDITION— RESIDENTIAL LOW DENSITY RESIDENTIAL 6007 Owner Contractor ------------------------ ------------------------ BROCKMAN JAMES R OWNER 45235 COLDBROOK LANE LA QUINTA CA 92253 -------- Structure Information 105 SQ. FT. REVISION TO 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 # BEDROOMS 1.00 FLOOD ZONE NO FIRST FLOOR SQ. FTG 105-00 ----------------------------------------------------------'------------------ Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 90.00 Plan Check Fee 58.50 Issue Date . . . . Valuation 6007 Expiration Date 3/09/05 Qty Unit Charge Per Extension BASE FEE 45,.00 5.00 9.0000 THOU BLDG 2,001-25,'000 45.00 ----'-------------------------------------------=---------------------------- Permit . . . . . . ELECT - ADD/ALT/REM Additional desc Permit Fee . . . . 18.68 Plan Check Fee 4.67 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/09/05 Qty Unit Charge Per Extension BASE FEE 15.00 105.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 3.68 --------------------------------------------------------------=-------------- Permit . . . . . . MECHANICAL Additional desc ti �W P.O. BOX 1504• QU&M VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Oq • (4 is { Date: g- Q - 0T - Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: 4/A Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 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. License Class License No. Date Contractor 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).): 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 I, 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 recon^ —If - WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty, of perj ne of the following declarations: _ 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 permit is issued. I have and will a' n workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is ssued. omp sation insurance carrier and policy number are: Carrier Policy Number I�e�rtifythat, in the performance 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. n Z') A WARNING: FAILURE TO SECURE ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRE OUSAND 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 T 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, indemnity 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 a to compty with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this co ty to enter upon the ve tinned property for inspection purposes. to �Iignature (Applicant or Agent): Page 2 Application Number . . . . . 04-00006124 Date 9/09/04 Permit Fee . . . . 15.00 Plan Check Fee . . 3.75 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/09/05 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional desc Permit Fee . . . . 15.00 Plan Check Fee 3.75 Issue Date . . . . Valuation . . . . 0 Expiration Date 3/09/05 Qty Unit Charge Per Extension BASE FEE 15.00 ------------------------------------------ Special Notes and Comments --------------------------------- 105 sq. ft. revision ------------------------------------------------------------- to existing permit --------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 5.85 STRONG MOTION (SMI) - RES .60 Fee summary Charged --------------------------- ---------- Paid Credited -------------------- Due Permit Fee Total 138.68 .00 .00 138.68 Plan Check Total 70.67 .00 .00 70.67 Other Fee Total 6.45 .00 .00 6.45 Grand Total 215.80 .00 .00 215.80