04-5264 (RER)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 NumberC04-000052 Date 7/09/•04
Property Address . . . . . . 4-&2-03 CALLE FLORISTAS
APN: 646-092-0.02-2 -20052
Application -description . REMODEL —RESIDENTIAL
Property Zoning LOW DENSITY -RESIDENTIAL
Application valuation 150.0
Owner Contractor
ARIAS RAUL. VANTAGE POINT'CONSTRUCTION.INC
48-203 CALLE FLORISTA.. 77245 INDIANA AVENUE
LA QUINTA_ CA 92253 PALM DESERT.. CA 92211:..
(7
200-0:563
200-0563
WCC.:: STATE FUND.:
WC: 2290022485 '01/01/05
.. CSLB : .473 99 6 .. 10/31/04
CCC: B -C10
Other struct .info .CODE EDITION 2.001
Permit . . . . . BUILDING PERMIT
Additional desc .
Permit Fee 35.00 Plan Check Fee 22.75
Issue Date Valuation. 1.500
Qty Unit Charge Per Extension
BASE FEE 15.00
10.00 2.00.00 .HND BLDG -5.01-2,000 20.00
Special Notes and Comments
WINDOW ADDITION
Other Fees ENERGY REVIEW FEE. :.2.28
Fee.summary Charged Paid Credited Due
Permit Fee Total 35.00 .00 .00 35.00
Plan Check Total 22.75 .00 .00 22.75
Other Fee Total 2.28 .00 .00 2.28
Grand Total 60.03 .00 .00 60.03
JUL 0 9 2004
: CITY OF LR GI1W7e
N
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Application Number. fl - Date:_
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Uc. No.
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
1 hereby affirm under penalty of perjury that 1 am licensed "under provisions of Chapter 9 (comm enang with Section 7000) of Division 3 of the Business and. Professionals
Code, -and -my ice s Min full force and e
Clffect.
l toense as3 I — G , (� LJNo. l t7
'� OVC on�
Date f ntrad�
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 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 (comrnencing 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.appkant for a permit subjects
the appficant to a civil penalty of not more than five hundred dollars.($500).)f
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 L.aw.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. T044, 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 contrador(s) licensed pursuant to
the Contractors' State b mse Law.).
U I am exempt under Sec. . , BA 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 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
_ I certify that, in the performance of("-work-for*tW this permit is Issued. I shill'
compensation laws of California. and agree that, it I should become subject to
forthwith comply with those provisions:
k
any person in any .manner so as to became subject to ft workers'
compensation provisions of Section 3700 of the Labor Code, I shall
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 ATTORNEYS 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 perrit is Issued.(Sec. 3097, Civ. C.).
Lender's 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 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 Quinta, 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 petit, 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. 1 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.
—�% Signature (Applicant or Agent):
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A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
NO EXCEPTIONS!
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
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APPROVED
FOR CONSTRUCTION
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