The URL can be used to link to this page

04-4575 (BLCK)'r I �F�Q�rw BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 922.53 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . ... . . 04-00004575. Date .5/25/04 Property Address 43605 GALAXY DR APN:. 609-560-001-1 -23773 - Application description . . . WALL/FENCE Property Zoning LOW DENSITY RESIDENTIAL Application valuation 2000 Owner Contractor STOLZOFF JEFFREY OWNER 43605 GALAXY.DR LA QUINTA. CA 92253 Permit ELEC-MISCELLANEOUS Additional desc Permit Fee 16.50 Plan Check Fee 4.13 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 .7500..PER ..ELEC.DEVICE/FIXTURE 1ST 20 1.50 Permit PLUMBING Additional desc.. Permit Fee 18.00 Plan Check Fee .5.25' 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 .Permit WALL/FENCE PERMIT Additional desc Permit Fee 45.00 Plan Check-Fe°e .00 Issue Date Valua,t✓ion /.. ��\\. 2000 Qty Unit Charge Per BASE FEE CC, 01---15:-00 2 . 0000' HND ' BLDG 501- ----------------------------- L --------------- Speci*al ----------------------------------------- Special Notes and Comments 18 LF_4' BLOCK WALL TO FORM ISLAND/BBQ ASNI Z21.58A/2. GFI OUTLETS. Extension 15.00 30.00 P.O. BOX 1504 QUh(rC4V 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: - 7S Date: Applicant: � Architect or Engi�1��_ • Applicant's Mailing Address: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 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 1 hereby affirm under penalty of perjury 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_#mthe-or-she-is-exempt4herefrom-and-the-basis-for-Ow-alleged-exempton: Anyviolabon of Sec6�031.5Wy any appricant fora permit subjects the9ppl'itant to a civil penalty of not more than five hundred dollars ($500).): , as owner of the property, or my employees with wages as their sole compensation, will do the worts, 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' State License Law.). U 1 am exempt under Sec. , BA P for this reason.. ate5A4— --0-W-ner —( W . KERS' COMPENSATION DECLARATION I hereby affirm under penalty of perju one of the following declarations: _ I have and will maintain a certificate of consent to self4nsure 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 . 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, a 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 pro*sion / WARNING: FAILURE TO SECURE W S' COMPENSATION C&AMUGE 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 1 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 it 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 1 have read this application and state that the above info n is cored. 1 a e to comply with all city and county ordinances and state laws relating. to building constructio , and hereby authorize representatives of this county to nter n then tlne abo�ntioned carps rty for inspection purposes. _4 ate ^S u�re On, g plicant or Agent): / Page 2 Application Number . . . . . 04-00004575 Date 5/25/04 Fee summary ----------------- Charged Paid ---------- Credited Due Permit .Fee Total ---------- 79.50 .00 ---------- .00 ---------- 79.50 Plan Check Total 9.38 .00 .00 9.38 Grand Total 88.88 .00 .00 88.88 FBU I`I-Y OF QUII�ITA' ILCING & SAFETY DEPT. ��0��N FOR CORSTRIJ DATE , BY - &22 -141 SO SHEETS 22-142 100 SHEETS 22-144 200 SHEETS �t3�o Cs� l y 19y 64