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04-6305 (DSF)a BUILDING & SAFETY DEPARTMENT x 1504 (760).777-7012 CALL,E TAMPICO FAX (760) 777-7011 ITA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 W�? A 2004 TAU BUILDING PERMIT ppYlcatAE�on� Number . . . . . 0-4=0-0"0065) Date ,9/14/04 Proge;rty:Address 4'6175 JEFFERSON ST AP' 649-071-013-22 -2190 - Application description . . . DEMO - SINGLE FAMILY Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 0 Owner -----------------------------"- Contractor CITY OF LA QUINTA -------- DEMO UNLIMITED, - INC. 78495 CALLE TAMPICO 81750 AVENUE 50 LA QUINTA CA 92253 INDIO CA 92201 (760) 775-5884 Other struct info . . . --------------------------------------------------7------------------------- . . NUMBER OF UNITS 1.00 Permit . . . . . . DEMO PERMIT Additional desc Permit Fee . . . . 45.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension ---------------------------------------------------------------------------- BASE FEE 45.00 Special Notes and Comments DEMOLITION OF EXISTING HOUSE AND ALL IMPROVEMENTS Fee summary Charged ----------------- Paid Credited Due ---------- Permit Fee Total -------------------- 45.00-n .'00 .00 ---------- 45.00 Plan Check Total .00 .0-0 .00 O Grand Total 45.00 .00 .00 45.00 P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: 1305 Date: V • / Architect or Engineer: Architect or Engineer's Address: Lic. No.. aA 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 Lice se is in fyyl>♦ l force and effect. ({ ?3 328 License Classss ' G L ,cense No. %/ OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I amexemQt 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 1, 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' Slate License Law.). U I am exempt under Sec. , B.& P.C. for this reason 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 is ued. workers' compensation m urance carrier a folic number are: Carrier workers' compensation Number AP �9 ,, 1.04 _ 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 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. WARNING: FAILURE TO SECURE WORKERS' C(OhOENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAN LLARS ($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 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 upon the above-mentioned property for inspection purposes. ate `7 "��i'�Y T ture (Applicant or Agent): _*4�L� a F CITY OF LA QUINTA BUILDING-&7SAFETY0 PARTMENT .777-70-1 Cl INSPECTION REQUEST LINE �71717153� Owner— 1lt,9F.,k"TTTN)A Contractor g Permit Number 04-6305 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 46-17.5 JEFFERSON STRFFT DEMOLITION OF EXISTING HOUSE AND ALL IMPROVEMENTS TYPE OF INSPECTION I DATE I INSPP, TEMPORARY POWER SETBACKS U/G PLUMBING / WASTE U/G ELECTRICAL/ GROUNDING FOOTINGS / STEEL CONCRETE SLAB DO NOT POUR CONCRETE UNTIL ABOVE SIGNED OKAY TO WRAP FRAMING (COMBINATION) Rn11[.H FI FCTRIC COVER NO WORK UNTIL ABOVE SIGNED INTERIOR GYP. BD. DRYWALL EXTERIOR LATH GAS TEST SEPTIC ABANDONMENT SEWER CONNECTION SEPTIC / GREASE INTERCEPTOR MASONRY INSPECTIONS FOOTINGS / STEEL BOND BEAM POOL / SPA / WATER FEATURE INSPECTIONS PRE-GUNITE / SETBACKS U/G PLUMBING U/G GAS U/G ELECTRICAL PRE -PLASTER ALARMS / BARRIERS FINAL INSPECTIONS TEMP. USE OF PERMANENT POWER ELECTRICAL PLUMBING MECHANICAL PUBLIC WORKS DEPARTMENT COMMUNITY DEVELOPMENT DEPT. FINAL / JOB COMPLETED ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING