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04-7321 (RER)M 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 . . . Property'Addresb . . . . APN: Application description P.roperty, Zoning Application valuation Owner -------------------------- STEVE FIGIOLA 78-179 HACIENDA LA QUINTA LA QUINTA CA 92253 04 - 0'0'0 0-73,21 78179'H-ACIENDA LA 646 -280 -014 - REMODEL - RESIDEN' LOW DENSITYRESID'. 7000 Date 11/17/04 F NOV 18 zuu4 JI: Contractor CJ'iACF LAQ1:2-jA FINANCE DEPT RESORT CONSTRUCTION P.O. BOX 68,01115 PARK CITY UT 84068 (435) 658-5051 WCC: Ex"MPT'l TATe FUS WC: t==CAT [8,qg740 015/.31/05 CSLB: 827016 1.1./30/05 CCC- B Structure Information GATE ENTRY Construction Type TYPRV - NONRATED Occupancy Type . . . . . DWELLG/LODGING/CONG,<=10 Flood Zone . . . . . . . . NON -AO -FLOOD ZONE Other struc,t info CODE ODE EDITION 2001 CBC ------------- -------- ------ ------- -------- Permit . . . . . . BUILDING PERMIT Additional desc. Permit. Fee . . . . 9:0.j00 Plan Check Fee 58.50 Issue Date . . . . Valuation 7000 Qty Unit Charge 'Per Extension BASE FEE 45. 0 0 5.00 9.0000 THOU BLDG 2,001-25,000 45.00- ------------ ------------------------- ----------------------- ---------- I ------ .,PermitELECT - ADD/ALT/REM Additional de'sc Permit Fee 18.50 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 1ST201.50 ------------------ ----------------------------------------------------- -------- Special, Notes and. Comme-nts GATE ENTRY 11./17/04 2:58:4,6 PM JJOHN90N -------------- --------------------------------------- ; ------- 4 ---------------- Other Fees . . . . . . . . .. ENERGY -REVIEW FEE 5.85 Fee summary Charged Paid Credited Due ---------- ff -------- ---------- ----------- ------------ ------ P.O. Bok 1,504' • �� 78495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT VOICE (760) 777-7012 FAX (760),777-7011 INSPECTIONS (760) 777-7153 Application Number: 0C/- 13A I Date: / / • 1 E3 Applicant:; Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address:. r Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION fherebyraffirm under penalty of perjury that 1 am licensed�underpvisions.of Chapter 9 (commencing with Sectlon 7000) of Division 3 of the Business and Professionals C and my License:' in full force and effect. �cense Class ense No- 192 ZEE OWNER -BUILDER, DECLARATION I hereby,affirm,under penalty of perjury that I am exempt from theContreaore"State Ucense.Law for the following reason (Sac: 7031,5: Business andlProfesslons,Code: Any city. or county that requiresa 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.sheIs licensed pursuant to the provisions,ofthe Contractors' State License Law (Chapter 9,(commencing with Section 7000) of Division 3 of the Business. and Professions Code) or thaGhe.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 nof:more than -five hundreclAollars ($500):); U' i, as owner of,the property,,ormy employees with wages as their sole compensation, will do the work, -and the structure Is not.intanded or offered for sale (Sec. 7044, Business and Professions Code: The Contractors'"Stale LicenseLaw 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 notintended.oroffered for sale. If,.however,;the building orimprovements 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,:grn exclustvely;contracting with licensed contractors to construct, the,project, (Sec: 7.044; 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 contractors) licensed pursuant to the Contractors' StateLicense, Law.). U I.am,exempt under. Sec. , 9.6 P.C. forthis,reason Date. WORKERS' COMPENSATION;DECLAR_ATION I,hereby afire underpenalty-of perjury oneof;the following declarations: I have,and..will maintain ,a certificate of consent:to,self-insure: for workers' compensation,, as provided for by Sectiorr3700 ofthe Labor Code, forthe performance of the workJor 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 ssworkers' workers' compensation insurance,carrier anrare:— Carrie .AA=J Sf1Lw— Policy Number Mlgrfcerufy that in the performance of the work for which this is issued, shall not empioy`any penton in any manner so as: to bei subject to the workers' • compensation laws,of California, and agree that, if I should become:subject to the'workeW compensation provisions of Section 3700 of the'Labor Code, I shall forthwith comply with those provisions. WARNING FAILURE`TO.SECURE WORKERS' COMPENSATION'COVERAGE ISrUNLAWFUL, AND:SHALL SUBJECT, AN EMPLOYER TO CRIMINAL.PENALTIES AND cMLFINES''URTO;ONEHUNDRED THOUSAND DOLLARS (V00,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS'PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST; AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirn.underpenalty of perjury that there'is;a;construction lending agencyfor the perfonnence.ofthe woik for. which -this perrriitls issued (Sec. 3097.0v. 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 GOt forth on this application. 1. Each:person upon whose behalf this application; is made; each person stwhose requestand,for whose benefit work is performed under or pursuant to any permit Issued a&a'resuit:of this application, the owneri and the:applicant, each agrees to, and shall, defend, indemnify, and hold harnless the Cltyof Le Quinta; its officers, agents and employees for a.ny,act oromission related to the work'being Wo led under orfollowing 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 pernit or cessation of work for180.days will'subject permit4o, cancellation. I certify that I have read this application andstatetitat the above information is correct. I agree to comply with all city and county ordinances and state laws, relating tmbulid'ng construction, and hereby authorize representatives of this county to enterupon;the°above�mentioned property for Inspection purposes. �� Smature (Applicant or Agent): Application.Number Permit Fee Total Plan Check Total Other Fee Total Grand Total Page 2 . 04-00007321 Date 11/17/04 106.'50 .00 .00 106..5.0 62.63 .00 .00 62.63 5.85 .00 .00 5.85 174.9'8 .00 .00 174.98