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04-8048 (AR)t a, BUILDING &SAFETY DEPARTMENT ox 4 F 8--CALLETAMPICO (760),777-7012 FAX (760) 777-7011 D LA a NTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 ��,lW��• BUILDING PERMIT flt ��� A cation Number . . . . 04. 00008048 Date '12/30/04 Property Address 53563 AVENIDA.NAVARR1D APN: 774-134'-013-3-000D00 Application description ADDITION*-'RESIDENTIAL Property Zoning . . COVE RESIDENTIAL Application valuation . . . . 22880 Owner Contractor .MEZA M JESUS ..Owner 53-563 AVENIDA NAVARRO LA QUINTA,.CA 92253 �j P.O. BOX 1504 78-495 CALLE TAMPICO � VOICE (760) 777-7012 LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 BUILDING '& SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 An lication KI"i, ' p Applicant: Applicant's Mailing Address: Date: Architect or Engineer wcnnect 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 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 stricture, prior to its issuance, also requires the applicant for the permit to rile 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" 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 aRpheant to a civil penalty of not more than five hundred dollars ($500).): Cbtrr 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 contractors) licensed pursuant to the Contractors' State License Law.). U I�atam exempt under Sec. ,BBA P.C. for this reason I� e V b Owner.:�1i7 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 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 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 insurance carrier and policy number are: Cartier Policy Number certify that, in the performance of 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. ✓Date Z!! f sS�Applicant � 2 6 1 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, 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 ATTORNEY'S FEES. I hereby affirm under penaltyof CONSTRUCTION LENDING AGENCY 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 IMPORTANT APPLICANT ACKNOWLEDGEMENT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth onthis a 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed unication der 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 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. ate . Signature (Applicant or Agent): C `Z.p /✓� �iy ���� •-� - - - - - - - - --- - - - - - - - - - - - - - - 0 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - �1. A libation Number a ". y`'04 -00008048 ~ ------Pp------------------- ------------- =---------------------------- --,--_-- ----- Structure Information 400 SQ. FT. ADDITION Construction Type . . . . TYPE -,V - NON RATED Occupancy Type DWELLG/LODGING/CONG <=10 Flood.Zone NON. -AO FLOOD ZONE Other struct info . . . . CODE EDITION 2001 CBC FLOOD ZONE NO 1ST FLOOR SQUARE FOOTAGE 400.00 Permit Additional desc Permit Fee Issue Date Expiration Date . BUILDING PERMIT .234.00 6/28/05 Plan Check Fee 152.10 Valuation . . . 22880 Qty Unit Charge Per' Extension., BASE FEE 45.00 ' 21..00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 189,.00 Permit. . . . . . . ELECT - ADD/ALT/REM Additional desc Permit Fee . . . 29.00 Plan Check Fee 7.25 Issue -Date Valuation 0 Expiration Date 6/28/05 Qty Unit .Charge Per Extension BASE FEE 15.00 400.00 .0350 ----------------------------------------------------------------------------- ELEC NEW RES - 1 OR 2 FP.MILY 14.00 Permit ". . . . . .. MECHANICAL Additional desc Permit Fee . . . . 57.50 Plan Check Fee 14.38 Issue Date Valuation 0 Expiration Date 6/28/05 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 1.00 .6.5000 EA MECH VENT FAN 6.50 Permit . . . . . . PLUMBING Additional desc Permit "Fee . . . . 45.00 Plan Check Fee 11.25. Issue Date Valuation 0 Expiration.Date 6/28/05 Qty Unit Charge Per Extension BASE FEE 15.00, 4.00 6.0000 EA PLB FIXTURE 24.00 1.00 3.0000 EA PLB WATER INST/ALT/REP- 3.00 1-00 3.0000 EA PLB GAS PIPE 174 OUTLETS .3.00 Special Notes and Comments BEDROOM,BATH ROOM & LAUNDRY ROOM ADDITION 400 SQ. FT. 12/30/04 3:1.8:21 PM ------- - - -- -:--,--,-------- ------ - - - - -- - -- --4 ---- ------------.-- ------------- A--lication Number PP----------- ------ .- .--04--------------------------=---.-------- -- 000.08048 Special Notes.and Comments JJohnson . Other Fees . . . . ... . ENERGY REVIEW FEE 15.21 STRONG MOTION (SMT) - RES 2.28 Fee summary Charged Paid Credited Due Permit' Fee Total .365.50 .00 .00 365.50 Plan Check Total 184.98 .00 .00 184.98 Other Fee Total 17.49 .00 .00 17.49 Grand Total 567.97 .00 .00 567.97 V x X x A A x Bin rF; City of La Quinta Building at Safety Division P.O. Box 1504, 78-495 Calle Tampico Permit U Quints, U 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: tS> 's Namc: r SUS A. P. Number: 4— � �� 4( Address: Leeal Description: 3 ��i�Loc City. ST. Zip: Contractor. D�jy ^ Q U�,L/� Address:.-sem V -v1 � 9 V, f,(� FTeiephone: %G., 6_9 Project Description: Cir)-, ST. Zip: Telephone:. 7L� State Lic. # : a City Lic. #: Arch.. Engr., Desigttcr. G L U Address: ,AAS%r City. ST. Zip: �-_ Telephone: 76g!!�, State Lic. #: = Name of Contact Person: /G �4� Construction Type: Occupancy: A r Project type (circle one): Newdd' Alter Repair Demo Sq. Ft.: # Stories: # Units: Telephone # of Contact Person. stimated Value of Proicct: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERNIIT FEES Plan Seti Plan Check submitted Amount Structural Cala. Reviewed, ready for corrections Plaa Check Deposit � Truss Calcs. Called Contact Person Plat Check Balance Energy Coles. Plans picked up z r 1 Construction Flood plain plan Plans -1": ab dined jJ Mechanical Grading plan 2" Review, ready fo correction ssue , Elettrical Subcontactor List Called Contact Person �l l l v plumbing Grant Deed Plans picked up S SALI. H.O.A. Approval Plans resubmitted I�Z/ice Grading IN HOUSE:. '• Review, ready for correcti(srissu Developer Impact Fee p Planning Approval Called Contact Person,M,� A.LP.P. Pub. Wks. Appr Date of permit issue School Fea Total Permit Fees )ij to PrB1CC, G A%a� — WV Vt W tf w[ 04 J, M 0 5 C�MOFT1 �4 78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 9225:3 TELEPHONE (760) 777-7012 FAX (760) 777-7011 _ OWNER/BUILDER INFORMATION Dear Property Owner:' An application for a building permit has been submitted in your name listing yourself as the wilder of the property improvements specified. ` For your protection you should be aware that as "Owner/Builder" you are "the responsible •pasty-of record on such a permit. Building permits are not required to be- signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her .name: Contractors are required -,by law to be licensed and bonded by the State of California and to _-iave a,business license . from the City or County. They are also required by law, to put their, license number on all permits for which :they apply. If you plan to do your own' work, with the, exception of various trades that, you plan to subontraci, you should .be aware of the following information•for your benefit and protection: ` If you employ or otherwise engage any persons other than yourimmediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or .subcontractors, then you may be an employer.' if you'are an employer, you must register with the State and Federal Government as an emplo-er and-you are subject to several obligations include State and Federal income tax withholding, federal social security, taxes; worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may.be financial risks for you if you do not carry out=these obligations, and these risks are especiallyserious with respect to worker's compensation insurance. - For more specific information about your obligations under Federal Law, contact the Internal &venue Service (and, if you wish, the U.S. Small Business Administration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is-intended for sale, property owners who are not licensed contracts are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontrac-or, only under limited conditions. A frequent practice.of unlicensed persons professing to be contractors is to secure an "OvrnerBuilder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be .signed .by property owners unless they are performing their own work personally. Information .about licensed contractors may be obtained by contacting the Contractors' State License Board in your community. or at 1020 N: Street, Sacramento, California 95814. t Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. . Very truly yours, , ... ' - :.,......--;�_.•w _. S.s.:. v _ _ r S'^^, _ __ ,Fes. _.. . �,�,,r� CITY OF LA QUINTA' DEPT. OF BUILDING AND SAFETY' ' 78-495 Calle Tampico La Quinta, CA 92253 (760) 777-7012 FAX: (760)' 777-7011 OWNER'S SIGNATURE/DATE PROPERTY ADDRESS D�-80:7E CZ PERMIT NUMBER(S)