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05-0019 (GRES)Is N T4kf 4 4 a" BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760),777-7012 8-495 CALLS TAMPICO FAX (760) 777-7011 n A QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 MAR 14 2005 U , 9=26 n Nu er o er v Address APN: Application description Property Zoning . . . . Application valuation . BUILDING PERMIT X05-000-00019 Date 1/11/05 . . . 52185 VIA CASTILE 772-410-998-6 -32453 - . . . GARAGE -•RESIDENTIAL . . . LOW DENSITY RESIDENTIAL . . . 12662 Owner --------------------------------- ND LA QUINTA PARTNERS 375 N FRONT ST STE 200 COLUMBUS, OH 43215 Contractor A & M CONSTRUCTION P.O. BOX 366 LA QUINTA, CA 92253 (760)564-4832 WCC: STATE FUND WC: 0009232-2005 01/01/06 CSLB: 746198 02/28/06 CCC: B -C10 P.O. BOX 1504 78-495 CALLS TAMPICD LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Address: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3• I l oS Architect or Engineer: Architect or Engineer's Address: Lic. No. _3_701P 6-3;°'roG 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 C e, and my Lice a is in full force and effect. / u (�r icense Class .cense No._ 1 7j 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 (commencing with Section 7000) of Divisiori 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 I, 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.C. for this reason Date Owner 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. j have and will maintain workers' compensation i rance, as required by Section 3700 of the Labor Code, for the -performance of the work for which this permit is j ed. works' compensation ins a wrier and policy n m are: artier s7 A r%�V D P icy Number _ 06 d *4Z-2Apoy any person in any manner so as to become subject to the workers'- 5 _ 1 certify that, in th rtormance of the work for which this permit is issued, I shall not employ compensation laws of California,a�md 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 provi8(ons. 52 WARNING: FAILURE TO SECURE WOR RS' 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.). Lender's Name I It Lender's Address �C 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, indemnity 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 cane tion. 1 certify that I have read this applicati nd state that the above into tion is correct I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authori presentatives of this county to ter upon the above-mentioned property for inspection purposes. /Date �J ` �� Signature (Applicant or Agent): ---------------------------------------------------------------------------- Application Number . . . . . 05-00000019 1---------------------------------------------------------------------------- Structure Information Construction Type . . . . TYPE V - NON RATED Occupancy Type . . . . . GAR, CARPORT, SHED, AG Flood Zone . . . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC FLOOD ZONE NO GARAGE SQ FTG 646.00 ----------------------------------------------------------------------------- Permit Additional desc Permit Fee . . . . Issue Date . . . . ELECTRICAL-CARPORT/GARAGE 27.92 Plan Check Fee 1.75 Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 646.00 .0200 ELEC ---------------------------------------------------------------------------- GARAGE OR NON-RESIDENTIAL 12.92 Permit . . . . . . CARPORT/GARAGE Additional desc . . Permit Fee . . . . 144.00 Plan Check Fee 23.40 Issue Date . . . . Valuation . . . . 12662 Qty Unit Charge Per Extension BASE FEE 45.00 11.00 9.0000 THOU BLDG ---------------------------------------------------------------------------- 2,001-25,000 99.00 Permit . . . . . . GRADING PERMIT Additional desc . . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . 0 Qty Unit Charge Per Extension BASE ---------------------------------------------------------------------------- FEE . 15.00 Special Notes and Comments 646 S.F. DETACHED GARAGE. 75% REDUCTION TO PLAN CHECK FEES DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE. Fee summary Charged Paid. Credited Due Permit Fee Total 186.92 .00 CIO 186.92 Plan Check Total 25.15 .00 .00 25.15 Grand Total 212.07 .00 CIO 212.07