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12-0089 (SPIN)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description: Property Zoning: Application Valuation: 12-00000089 48773 CLASSIC DR 658-130-011-5 -31379 - SPECIAL INSPECTION LOW DENSITY RESIDENTIAL 1500 c&ht 4 4 Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: DAN GATTI 48773 CLASSIC DRIVE LA QUINTA, CA 92253 Contractor: NICHOLAS INC, TD P.O. BOX 1543 WILDOMAR, CA 92595 (951)245-2559 Lic. No.: 581497 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/01/12 2612 r 1 'I'T`S OF !.A,— TA ------------------------------------------------------------------------------------------------— . 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, License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided Lice Class: B Lice o.: 1497 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Date: C ractor: $l 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 OWN ER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of peri that I am exempt from the Contractor's State License Law for the Carrier EVEREST NATL Policy Number 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 th r rs' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of tDAabor.Codq�all forthwith cgp6ply wil&xhose provisions. 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 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.). (_ 1 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.). (_ ) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: 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 WARNING: FAILURE TO SEC E RKERS' CO PENS N COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TOC AL PENALTIES-AMCIVIL FINES UP TO ONE HUNDRED THOUSAND 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. 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 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 upo he above-mentionedprope ection p Date: �� gnature (Applicant or Age ur ses a Application Number . . . . . 12=00000089 Permit . . SPECIAL INSPECTION Additional desc Permit Fee . . 100.00 Plan Check Fee .00 Issue Date Valuation . . . . 1500 Expiration Date 7/30/12 Qty Unit Charge Per Extension .BASE FEE 100.00 ---------------------------------------------------------------------------- Special Notes and Comments' SPECIAL INSPECTION TO REPLACE 2 LAYERS DRYWALL@ PARTY WALL IN MASTER BATH. SEE APPLICATION FOR DETAILS. 2010 CODES. Fee summary Charged Paid Credited Due ----------------------- Permit Fee Total 100.00 .00 ---------- .00 .100.00 Plan Check Total .00 .00 .00 .00 .Grand Total 100.00 .00 00 100.00 LQPEPMIT Bin, Permit # n ,� VI 0, Project Address: City of .La Quinta . Building 8L Safety Division P.O. Box 504,78-495 Caife Tampico La.Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name:. A. P. Number. Address: . L Legal Description: Contractor.0 6C4^ City, ST, Zip: Telephon : ` " Address: — Nerx Description: City, ST, Zip: 40.1 Telephon q 5 ys Zs's State Lic. # : J•CityLic. #: e-Jf CL Arch4 Engr., Designer. Z -Z4 S L 'Address: j L-A.)4a City., ST, zip: /d)C> i D �lb Telephone:Construction State Lic. #: Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # unigr. Name of Contact Person: Telephone # of Contact Person: Estimated Value of Project: 71 " APPLICANT: DO NOT WRITE BELOW THIS LINE k Submittal. Plan Sets Req'd Recd TRACMG PERMYFEES Plan Check submitted Item Amount Structural Calea Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calci. Plans picked up Construction Flood plain plan Pians resubmitted Mechanical Grading plan 2'j Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up &f*LL H.O.A. Approval Plans resubmitted Grading IN HOUSE-, '^' Review, ready for correcdonsAssae Developer Impact Fee Planning Approval. Called Contact Person A.I.P.P. Pub. Wks: Appr " Date of permit issue School Fees Total Permit Fees