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04-4199 (RER)BUILDING -& SAFETY DEPARTMENT, P.O. Box 1504 .(760).777-7012 OF 78-495 tALLE TAMPICO FAX (.760)- 777-7011 LA QPINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-715,3 BUILDING PERMIT Applibation.Number . . . . 104-000.04_199_",, Date 5/13/04' Property Address . . . . . .. 57870 TROON WY APN: 761 -850 -010 - Application description -REMODEL -,RESIDENTIAL- Property Zoning LOW DENSITY RESIDENTIAL. Application valuation 2000 Owner Contractor : -------------- WEISKOPF PARTNERS I - ------ -------------- KAHUILLA CONSTRUCTION INC, 55161 SOUTHERN HILLS P'.O.'BOX 366' LA QUINTA- 3 -LA QUINTA CA 92253 (760.) WCC:. EXEMPT MAY 14 2004, WC: EXEMPT 08/12/04 CSLB: 783503 08/31/04 CCC: B -C10 -------------- - - - - ar-Y.OF LAQUIN tru 7 DE u'r*e Information, --------- ------- ANCE Construct NON RATED. .0ther,struct info,,. CODE EDITION 2001 ------------------------------------ Permit BUILDING --- PERMIT Additional desc. Permit Fee 45.00 Plan Check Fee 29.25 Issue Date Valuation. 2000 Qty- -Uni.t.Charge Per* Extension BASE FEE 15.00 15.00' 2.0000 HND BLDG 50172,000.,- 30.00 ---------------- ------------------ ----------- 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 _00 .3-0000 EA ----------- ------- ----------- : PLB GAS PIPE 1-4 OUTLETS 3.00 7 Special Notes and'Comments -------------------------- ----------------- PATIO FIREPLACE PER-AP'PROVED.PLANS ------------- Other Fee Other-Fees . . .. . . . . ----------------.--------- ------------------7------- . . ENERGY REVIEW PEE - 2.93 STRONG MOTION (SMI) RES .50 P.O. Box 1504 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 Todf INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: d . 9>! 99 Date: Applicant: Architect or Engineer: Applicant's Mailing Address: Archite t or Engineer's Address: Lic. No.. t3UILUING 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 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 Llcense 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 aany 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 thevork, 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.). In I, as owner of the property, am exclusive) contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' /C State License Law does not apply to a 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 am exempt under Sec. B. .C. for�pis�reon�o� ' Date WORKERS' COMPENSATION DECLARATION hereby affirm under penalty of perjury one o e 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 olicy Number _Zlcerfity that, in the performance oft 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 Califomi d 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 pr "s n Date 15 —02— 0!4Applicant WARNING: FAILURE TO SECURE WORKERS' OM ENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAN LARS ($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 oTAA rlury 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 1NII Lender's Address N/tiQ 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, e 1 suant PP 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 ap icant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission rel ed to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes II and void if is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to ca ation. I certify that I have read this application and state that the above i o agree ply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this count er u ve-mentioned roperty for inspection purposes. Date 9.6 -13—o*, Signature (Applicant or.Agenty, Page 2 Application Number . . . . . 04-00004199 Date 5/13/04 Fee summary ------------- Charged Paid Credited Due Permit Fee.Total 63.00 .00 .00 63.00 Plan Check,Total 33.75 .00 .0.0 33.75 Other Fee Total 3.43 .00 .00 3.43' - Grand Total 100.18 .00 .00 100.18 _ I f . rCITY OF I BUILDING & SAFETY DEPT. I APPF�OVED 4.. — I ..FOR CONSTRUCTION =J.- t-�PT .L��If�Tlo►•! DATE S Olt gy .......... -- -- - - ..... _... - .._ _---------- ---- -. _ 48`u� A RE -INSPECTION FEE OF $30 ' WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A. SCHEDULED O 'INSPECTION. NO EXCEPTIONS!* .; .. .. ',:. .. f� • �S a*L 4 100.00' ft 0:5% • - 0.5� 4 �. `��`� • ' MIN. ` .. MIN. 00 pp 35 _ 1 HT • J 10.01. 455 E1 1128' ry FF =456.80 .Z 1 .48', z ' PAD=456.30 o w pg6�0 �o g .. 4 0 ZA •, 0. 10.001 5® 13 10.01 ' 19 30' — _ ol LO o -- " ..C:> 100.00'