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04-4425 (AR)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).777-7012 78-495 CALLS TAMPICO FAX -(760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7-153 BUILDING PERMIT Application Numb6r 04-00004425 Date! 5/19/04 Property Address . . . . ... 81075 SHINNECOCK HILLS APN: 762-330-010-'23 -29147 Application,description . . . ADDITION - RESIDENTIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation.. 6192 Owner Contractor - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- _ SOUTHERN HILLS DEV.INC KAHUILLA CONSTRUCTION INC. C/O JOHN.READ P.O. BOX 366 55395 SOUTHERN HILLS LA QUINTA CA'92253 LA QUINTA CA 92253 (760) WCC: EXEMPT WC: EXEMPT CSLB: 783503 CCC: B -C10 ------ Structure Information- EXTENDED PATIO AND ADD FIREPLACE 'Construction Type . . .. . . TYPE V - NON RATED Occupancy Type .. . . . . . DWELLG/LODGING/QONG <=10 Flood Zone NON -AO FLOOD ZONE Other,struct info . . . . . .CODE EDITION 20 FLOOD ZONE N PATIO SQ FTG -----------------.----------------------------------------- -- Permit . . . . . .. BUILDING PERMIT Additional desc 08/12/04 08/31/04 Permit Fee . . . . 90.00 Plan Che ee 8.50 I*ssue Date . . . . Valu t 6192 Qty Unit Charge Per Extension BASE FEE 45.00 5.00 9.0000 THOU BLDG 2,001-25,000 45.00- 7 - - - - - - - - - - - - - - - - - - - - Permit . . . . . . - - - - - - - - - - - PLUMBING - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Additional desc Permit Fee . . . . 18.00 'Plan Check'Fee'. 4.50 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ------------------------------------- Special Notes and Comments -------------------------------------- 'EXTEND PATIO AND ADD FIREPLACE,,,,.., P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: U Date: -- F -WF %'aii 0 ate:Applicant: I Architect or Engineer: Applicant's Mailing Architect or Engineer's Address: �_) r 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 License is in full force and effect. 7 0;P / Licensee Class 2 ssss Lir ' License No./ll �� G ' /Gate 7— 7 —&Z CnntrartM ./iIYvv--�.We OWNER -BUILDER DECLARATION I hereby affirm under penalty of perj that 1 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).): U 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. , B.8 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 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: Carrier Policy Number I 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 s 'act to the workers' compensation provisions of Section 3700 of the Labor Code, I shall ifortthhyAtthtccomply with those provisions. Date WARNING: FAILURE TO SECURE RKERS' 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 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 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 'thin 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 1i correct. I gree to ply all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county t� thew -men ' perty for inspection purposes. ate L,0 nature (Applicant or Agent): Page 2 Application Number 04-00004425 Date 5/19/04 ----------------------------------- --------- ----------------------------------------------------------------- Other Fees . . Other 1 . . . . .•. 7 ----------------------------------- ENERGY REVIEW FEE 5.:85 STRONG MOTION (SMI) - RES .61 Fee summary Charged Paid Credited. Due Permit Fee Total 108.00 .00 .00 108.00 Plan Check Total 63.00 .00 .00- 63.00 Other Fee Total 6.46 .00 .00' 6.46 Grand. Total. 177.46 00 00 177.46 n_0 ft ;1, J CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS PERMIT NUMBER OWNER 1049:5ZLLG BUILDER_ 1CC-�f7Tt'►'1� / �IS /L1►1 � This form shall be ousted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on thisfob. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit_ For each anolicable trade, all information reauested below must be completed' by applicant. `On File' is not an acceptable response: Trade !Classification ' Coritrector state Contractor's License workers Compensation Iriiurance City Business License Company Name Classification Ucense Number Exp. Date Carrier, Name Policy Number Exp. Date License Number Exp. Date' (e.g. A, B. C-8) (xxxxxx) , (xx/xx/xx) (e.g. State Fund, CalCompl (Format Varies) . (xx/xx/xxl (xxxx) (xx/xx/xx) `EARTh(WORK (C-12) ;..;`::' A•F�t2<s �tti31.11f ('vi�i71 G -!L 6(G�1Ds -,�( fWAV 6o!%S/3-vl2 1 /vis po�1`i7 3 Zl-CS CONCFtETE;(C-81.; <" Cor•!S%iZJGi�atl (►1G -S ��B/PZ� %S�lP�9� %�3i/`JJ �0jr,= C--t0.repdov,, FckJp 0LKRCi��'"7SS3 Ill 1j 04e( 014d17e40 `72 t A ADtoZU AFRA�ICd FRAMING.(C=51 Fr' `^ >z`: // �� G'6rJ�R;I�OnI Co $rt G/a Z7.7f�fj ,STRUCT r,ST.;E::.Et: v5�Q1 s y�ELDtl CS� !pAbpY�1'1-l l O�t 1py MASONRI� IC 291`3e^'`^ '. ...... ... ...:......:. SA&a /KA$OnIR� G' 2'P Co��}4�� v,cLAao�Q (awe ��/-rZ3f29's yet l05 442/4 SOfSicL(�i41(tLj}L G-3tP 51999'%ir?L?"�'s�if✓// •�/TER(C ,c/M/�ora7�-4 / d//4z. 35� MAK i SIA J!K,/v(au_ f ��L.Lf C' 3 7?G4�9,y1y p(Q Oi�r4.W� S:/P7g%O r/ / �JDRYW4L(C9) 12- ^-;;^",:AA9tJAVXV-A14I-L r�Rr <-Q 7-Za�'T 3152.1d 15 30 p 3l ✓%��QO Sim �v 5rG7S>Qod /�./�V40it y / )::FIVACIG2Qf;. 5 eWAGi 1,A.4,0- c-�� ELFC7RICAl <jC=101;,' °?,, , (F�Rr4 G_ /e 78/71 42aI �3�/z8/j J/E 2/ Ir �•ufi f12-29'—� ; :.,. .! El"ie t�A�D mar"' �j !tG, 4 34 ,d o 77 �i� N 4�' o / � ✓ 28.�- IVZO x15'97 ' % u 9 --74- SHEEt (VIET%11 (C 3f a '*? g,,FW S t i -AQ871 c. 2d 3g2�o.3 �b 's� S+_T__ f►rJD I_rwIPfa V5 FLOORING'' C=i5 Z:> f tc�� : _ 1 `.5 Co v(o 49 5 % d 70 5 to/i - `� � �`I QLAZING.(C17)`''i.'`> °s`r Cdj.,)TXlcrlB4,COx,f444-- a-17 77c'600 79'/'sls'/. iO3/l0 31 0r�F�vv A�tr�ruaN v�/b.4 96 IivsU%itloni'tc-i►.:..:s,,.:; N/�sR/J /�cIS./!,�(Tiop/ C �. SEWAGE bi" AC 2):? ;, 4rr�wfLL�Gat jCtf�Y1TiF Po,Ftc r+4F�%s t�sC� St`` C s PAINTING (C=33)' ` ' GI TE t(i I i1Ci , _ t75 i,� /Iz9c9�33?/,�, 1 ,1W C7 ��-� 1�1 ! �`J Cy -I cEwMlc nLE (c-5s.:�(0 5'li, U (0318 3" 7, 1-6 CABINETS (C4f: .; � I13 t�b/ne�S 8�•s Jy�J /44/Q i/I �5 FENCINOIC=]3Y'=:'..:':' SRde(2 /�ASor11Z>' L-2'! /P`j99m'S %ViLlAr�ot/I4 /riS:lRpik6 v;lc�i-/431291 t >c Ofo2rzl -Z 05 LANDSCAPING (C=271::`; (�X rr,r tlC I �_ '� 8`1 3/ �►,eol, lx }rfrar�r� �3vvt la q12 POOL (C-53) /t i • i / (�" 1 at ' % '_59914D/ �t lILI . 3 Z l t" D o"� (�1