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04-6874 (AR)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 _ (760).777-7012 78-495 CALLE TAMPICO ' FAX.(760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 04-00006874 Date 10/22/04 Property Address . . . . . . �a5.154__LAUREL VALLEY APN: 775-340-006 - _ - Application description . . . ADDITION - RESIDENTIAL Property Zoning . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . 862 Owner Contractor ------------------------- ------------------------ RIVIERA VILLAS FIRST PACIFICA DEV CORP 1651 E 4TH ST NO 228 300 EAST STATE ST, SUITE #100 SANTA ANA CA 92701 REDLANDS CA 92373- (909) 798-3688 WCC: STATE'FUND WC: 00083532004 01/01/05 CSLB: 760044 03/31/05 CCC: B ------ Structure Information CASITA CONVERSION/ADDITION ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . GAR, CARPORT, SHED, AG Other struct info CODE EDITION 2001 GARAGE SQ FTG 44.00 ---------------------------------------------------------------------------- Permit BUILDING PERMIT Additional desc Permit.Fee . . . . .23.00 Plan Check Fee 14.95 Issue Date . . . . Valuation . . . 862 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 2.0000 HND BLDG 501-2,000 8.00 ------------------------------------------------- .d,--------------------------=-- Permit ELECT - ADD/ALT/REM Additional desc Permit Fee 15.88 Plan Check Fee 3.97 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 44-.00 .0200 ELEC GARAGE OR NON -ESA .88 ---------------------------------- -- ��--�---- - - - -- ----------------- Special Notes and Comments Casita conversion/addition to CRW OCT 2 2 2004 #0311-075: Convert 59 sqft of casita to golf cart garage with an additional 44 cITYOFu►ouINTA sgft golf cart garage addition. FINANCEDEPT. ------------- Other Fees . . . . . . . . ENERGY REVIEW FEE 1.50 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: /0-za Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect 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 in full force and effect. Y License Class '10111ML'icense.No. L 00 Date t U I Contractors OWNER -BUILDER DECLARATION 1 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 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 ($500).): U I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , B.& P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is i$sued. My workers' compensation insurance carrier and policy number are: CarrW^— 61-41.. "WPo icy;Number'n t' O 0 3? 3 2,p o --.tea..., _ 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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall (j� forthwith comply with those provisions. Date—1 -t Z C/_1 APPpant*e '4 -11,e - WARNING' FAILURE TO SECURE WOeTEREST, S. COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDREDTHND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, 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 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 this county to enter uponthe above-mentioned property for inspection purposes. Date vil Signature (Applicant or Agent), N e Page 2 Application Number. . . . . . % 04-00006874 Date 10/22/04 -------------------- Fees . . . . . . •. STRONG MOTION (SMI) - RES .50 " Fee summary ----------------- Charged ---------- Paid Credited Due Permit Fee Total 38.88 -------------------- .00 .00 ---------- 38.88 Plan Check Total 18.92 .00 .00 18.92 Other Fee Total 2.00 .00 .00 2.00. Grand Total 59.80 .00 .00 59.80 *r - FEB -11-2005 FRI 02;37 PM THE PALMS 01/31/2005 09:49 7605649849 I I CITY OF UA QUINT CZv BUILDING & SAFETY DEPARTME 7"-7012 INSPECTEON RF.QUEEST LINE m► -71 s3�� Owner 1era Villus Contraotor Fi� rs��fica Dom -Co Permit NumbQr4��g?a - POST ON J06 IN CONSPICUOUS PI.AtE INSPECTOR MUST SIGN ALL APPLICABLE SPACES J013 ADDRE=SS 55-154 Laurel V&119Y' Capita conversion/addition to CRW#0311.075: Corvert 59 jgft of caotta to goat uw( garagc with an ABOVE APPROVALS DO NOT INCLUDE RIGHT TO r FAX N0. 7607778680 S P. 02 + rAut nx ' CITY OF LA QUINTA BUILDING & SAFIFTY DEPARTMENT 717-7012 INSPECTION REQUEST LINE 777-7153 Owner_GENERAL RANK Conimc:tor PACTFICA DEVELOPMENT _ Permit 1ombsr (1311!075 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES_ JOB 91DRESS 55-154 LAURFL VALLEY SFD - LOT 6, PLAN 2& PERAHT DOES NOT XNCIA 81,000 WALLS, POOY., SPA OR DRIVEWAY APPROACH, ABOVE APPROVAL$ GO NOT INCLUDE RIGHT TO