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04-5140 (AR)P.O. Box 1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760)777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number 04-00005140-_ Date 6/30/04 Property Address 81065 GOLF VIEW DR. APN: 762-280-006- - - Applicat.ion description ADDITION - RESIDENTIAL Property Zoning LOW DENSITY RESIDENTIAL Application valuation.. :. 19311 Owner Contractor OUSTER JACK W BK CONSTRUCTION 81065, GOLF VIEW DRIVE. 78355. CRES;TVIEW. TER LA -QUINTA. CA 92253 LA QUINTA CA 92253 • , , (760) .777-i_933 . .:WCC:: EXEMPT WC: EXEMPT. 10/21/04 CSLB: 818349 03./31/.05 CCC: `.. B.. 03/31/05 -.=---=.. Stru:cture:.::%nformation ADDITION TO •CASI.TA. 239 SQ-., FT... --.--- Construction Type . . . . .. TYPE V - NONRATED Occupancy Type DWELLG/LODGING/CONG <=.10 Flood Zone NON -AO FLOOD ZONE Other struct info . . . . . CODE'EDITION 2001 CBC # 'BEDROOMS . , .. 1 . 00 FLOOD ZONE.. NO FIRST .FLOOR SQ FTG 239.00 ...Permit BUILDING PERMIT -Additional.- desc Permit Fee 153.00. Plan Check Fee 99.45 Issue Date Valuation 13671 Expiration Date 12/24/04... Qty Unit -Charge Per Extension. BASE FEE 45.00 .12..00 9.0000 THOU. BLDG 2,001725,000 108.00 Permit . . . . ELECT - ADD/ALT/REM Additional desc Permit Fee . . . . 36.87 Plan' Check Fee 9.22 Issue Date Valuation 0 Expiration. -Date 12/24/04 .:Qty Unit Charge .Per Extension .BASE FEE 15.00 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: Date: fo 30 - OY Applicant:Architect or Engineer: v � 0 /V T,� c 7-0 (L -- Applicants 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 Liceose in full force and effect rLicense Class 45 License Nom �i/8.?% 9 Date %—) r D —Contractor ' K • COA , (c% , i d A 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 tD construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for the permit tD 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 doilars.($500).): U 1, as owner of the property, or my employees with wages es 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 rat 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 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: . _ 1 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, forthe performance of the work for which this permit is 15sued. My workers' compensation insurance carrier and policy number are: Cartier b / Policy Number _ I certify that in the performance of the work for which ties permit is issued. I shall not employ any person in any.marmer 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 forthwith comply with those provisions: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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 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.). Lenders Name Lenders 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 word 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 Quinta, its officers, agents and employees for any act or omission related to tf)e work being performed under or following issuance of this permit 2. Any permit issued as a result of this application becomes null and vold 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. 1 certify that I have read this application and state that the above information is correct. l agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorze.representatives of this county to enter upon the above-ai ntioned pro inspection purposes. Date�711 wy Signature (Applicant or Agent):++ t �.Y r I Page 2 Application Number . . . . . 04-00005140 Date 6/30/04 Qty Unit.Charge Per Extension 239.00 .0350 ELEC NEW RES - 1 OR 2 FAMILY 8.37 18.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 13.50 ---=------------------------------------------------------------------------ Permit . . . . . . MECHANICAL Additional desc Permit Fee . . . . 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 12/24/04 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00 ---------------------------------------------------------------------------- Permit PLUMBING Additional desc . . Permit Fee . . . . 15.00 Plan Check Fee 3.75 Issue Date .. . . . Valuation . . . . 0 Expiration Date . . 12/24/04 Qty „Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments ADDITIONAL ROOM ADDED TO EXISTING CASITA. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 9.95 STRONG MOTION (SMI) - RES 1.36 Fee summary Charged ------------------ Paid Credited Due --- Permit Fee Total - ------ ---------- 228.87 ---------- ---------- .00 .00 228.87 Plan Check Total 118.42 .00 .00 118.42 Other Fee Total 11.31 .00 .00 11.31 .Grand Total 358.60 .00 .00 358.60 CITY OF LA QUINTA SUB -CONTRACTOR LIST JOB ADDRESS ��_�� G�iry/e►,� �� PERMIT NUMBER p�-S'l�0 OWNER Ja f< C��-P •v BUILDER -� • ran Sfrt 4, 'm . This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance Dt building permit. ror each applicable trade, all intormation requested below must be completed by applicant. "Un rue" is not an acceptable response. 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