05-1225 (AR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA .QUINTA, CALIFORNIA 92253
Application Number: 05-00001225
Property Address: 45275 SUNBROOK LN
APN: 604-302-005-16 23995 -
Application description: ADDITION - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL.
Application valuation: 6016
Applicant:
TAW
, f.4
BUILDING & SAFETY DEPARTMENT
..BUILDING PERMIT
r
Architect or Engineer:
JUL 18 2005
CITY OF LA QUINTA
VOICE (760) 777-7012
FAX '(760) 777-7011
INSPECTIONS (760) 777-7,153
Owner:
M/M MERCADO
45275 SUNBROOK LANE
LA QUINTA, CA 92253
Other struct info . . . . C
Contractor:
Owner
DITION 2001 -CBC
Lic. No.: ---------------
Date: 6%27/05
_________________________________________________________________________________________________
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, and my License is in full force and effect. - _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: License No.: - - - - - - - - - - - - - - - . for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
' issued. -
Date: Contractor: _ 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
OWNER -BUILDER DECLARATION insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier NO Policy Number E FOOTAGE
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to ✓ 1 certify that; in the performance a work for which this permit is issued, (.shall not employ any
construct, alter, improve, demolish, or repair any structure,'prior to its issuance, also requires the applicant for the Y� person in any manJsoasbecome 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 ome subj ct to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions'Code) or 3700 of the Labol comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).: Date: —Applicant:
1 O�CLJIas 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 WARNING: FAILURE TO SECURE WORK ATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES D CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). APPLICANT ACKNOWLEDGEMENT
(_) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. -
property who builds or improves thereon who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors', State Lic se Law.L whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_ 1 I am exempt under Sec. , B.&P . for this reason the owner, and the, applicant; each agrees to, and shall defend, indemnify and hold harmless the City
tIt I 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.
Date: Owner: - 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(permir cessation of work for 180 days will subject
CON CTION NDING.AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there i a constr n lending agency for the performance of the I certify that I have read this application and state that the armation incorrect. I agree to comply with all
work far which this permit is issued (Sec. 3097, Civ. .. city.and county ordinances and state laws relating to buildinction, dhereby authorize representativesof this county to enter upon the above-mentioned property f'on u es.
Lender's Name: -
Date^�6ignature (Applicant or Agent):
Lender's Address:
LQPERDIIT
Application Number
05-00001225
Permit' . .
BUILDING PERMIT
Additional desc
Permit Fee
135.00 Plan Check Fee
58.50 .
Issue Date . . . .
Valuation
6016
Expiration Date
.12/19/05
QtyUnit Charge
Per
Extension
BASE FEE
90.00
5.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000.
45.00
Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
35.60.= Plan Check Fee
5.15
Issue Date :..;_
Valuation . . .
_ _ 0 _.
Expiration Date
12/1.9/05
Qty 'Unit Charge
Per
Extension
BASE FEE
30.00
160.00 .03.50
----------------------------------------------------------------------------
ELEC NEW RES - 1 OR 2 FAMILY
5.60
Permit.
MECHANICAL
Additional desc .
Permit Fee
54.50 Plan Check Fee
9.88
Issue Date . . . .
Valuation
0
Expiration Date
12/19/05
Qty Unit Charge
Per
Extension
BASE FEE
30.00
1.00 9.0000.EA
MECH FURNACE <=100K-
9.00
1.00 9.0000
EA MECH B/C <=3HP/100K BTU.
9.00
1.00 6.5000
EA MECH VENT FAN
6.50
Permit
PLUMBING
Additional desc .
Permit Fee"
76.50 Plan Check Fee
15.38
Issue Date
Valuation
0
Expiration Date
12/19/05
Qty Unit Charge
Per
Extension
BASE FEE
30.00
3.00 6.0000
EA PLB FIXTURE
18.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00.
1.00 7.5000
EA PLB WATER HEATER/VENT.
7.50
1.00. 3.0000
EA :PLB WATER INST/ALT/REP
3.00
LQPERMIT
Application Number
05-00001225
Permit PLUMBING.
Qty Unit Charge Per
Extension
1.00 3.0000 EA PLB.GAS
PIPE 1-4
OUTLETS
3.00
Special Notes and Comments -
permit .was charged double fees
for
-
starting to soon.June 22, 2005
11:07:28
-
AM jjohnson
Other Fees . . . . . . ..ENERGY
REVIEW
FEE
5.85
'
STRONG MOTION
(SMI) - RES
.60
Fee summary Charged
Paid
Credited
Due
Permit Fee Total 301.60
.00
.00
301.60
• ..Plan Check Total 88.91
.00
.00
88.91"
Other Fee Total 6.45
.00
.00
6.45
Grand Total 396.96
.00
.00
396.96
LQPM11T
;