05-4168 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: C"�05-00004168 '
Property Address: 47355 VIA RAVENNA.
APN: 643-100-005-185 -26152
Application'description: STRUCTURES OTHER THAN B
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 9000
Applicant: Architect'or nginee
SEP 2 3 2005 19)
Owner:
M/M CHISHOLM
47-355 VIA RAVENNA
LA QUINTA, CA 92253
VOICE (760).777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/23/05
Contractor:
MURDICA CUSTOM CONCRETE, "LOUIS
73310 HILLTOP ROAD
DESERT HOT SPRINGS, CA 92241
(760)341-9899-
Lic. No.: 791195
- LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
. I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with -
I hereby affirm -under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for, workers' compensation, as provided
- License Class: C8 License No.: 791195 -
_
.far by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued. -
Date: Contractor: -
_ 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I her affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier V BROOK' INS Policy Number RPSI1119402
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit toI
certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
- person in any manner so as to become subject to the workers' compensation laws of California,
- permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
nd agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the LabornCshall forthwit comply t se provisi s.
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).:,
- ; . j
Y
te: A ant:
(_ 1 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
WA NI : FAILURE TRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND -
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If,however, the building or improvement is sold within
.SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
- one year of completion, the owner -builder will have the burden,ofproving that he or she did not build or
improve for the purpose of sale.). -
APPLICANT ACKNOWLEDGEMENT
1_' T I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
- 7044,.Business and Professions'Code: The Contractors' State License Law does not apply to an owner of -
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed
t 1. Each person upon whosebehalf this application is made, each person at whose request and for '.
pursuant to the Contractors' State License Law.).
whose benefit work is. performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt u er Sec. , B.&P.C. for this reason _
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quints, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
ate: caner: L9
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ: C.).
citynty ordirjonces and state laws relating to building construction, and hereby authorize repres natives
- -
of this toe exon t above-mentioned prop . , for ins ection oses.
Lender's Name:
•
ey
/y -
te: nature (Applicant,or Agent):
. Lender's Address: /�\
--
LQPERMIT - - -
Application Number 05-00004168
Permit BUILDING PERMIT
Additional desc .
Permit Fee' 108.00.', Plan Check
Fee'.
70.20
Issue Date Valuation
9000
Expiration Date 3/22/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
' 7.00 9.0000 THOU BLDG 2,001-25,000
63.00
---------------------------------r--------------------------
Special Notes and Comments
BOAT DOCK PER ENGINEERED PLAN/HOA
APPROVAL ON.FILE
- ---------------------------------------------------------------------
Other Fees . . . . . . ENERGY REVIEW FEE
7.02
' STRONG MOTION.(SMI)
- RES
.90
Fee summary Charged Paid Credited
Due
----=------------ - ------ ---------- ----------
Permit Fee -Total. 108.00 .00
-"---------
.00.
108.00
Plan Check Total 70.20 .00
.00
70.20
Other Fee Total 7.92. 00
00
.7.92
Grand Total 186..12 .00
.00
186.12
' LQPERMIT
Bin #
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City o.f La: Quinta�
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BuIIding Safety Dlvlsion '
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Permit #
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} Building Permit.Application and Tracking. Sheet.
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Project Address: : S Owner's Name: Fj L
A P.'Number: Address:. �.
Legal Description: C� ST Zi �+
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Contractor: Iephode:�,24 4 '7 7 ,-7102
Address:? - j (' ` - Project Description:
City, ST, -Zip:.
Telephone/')b0,'.
State Llc: # ' ' , City Lie. #:77
-Arch.�Engr., Designer:
Address. 4oJ4.7
e x
City; ST Zip:
Telepho O �'
Type: `Construction T e - w 4
Occupancy:
Project.type (circle o e): New' Add'n Alter,.,; epair, 'Demo
State Lie. #' - ''
Name of Contact.Person: q. Ft.: ` # Stories: F ,
*#,Units: 4 '
Telephone #'of Contact Person: Q - T 7— Estimated Value of Project: • : �� '�
- APPLICANT: DO NOT -WRITE BELOW THIS LINE _ •_
' #
Submittal; '
Req'd,
Recd
- TRACKING .
PERMIT FEES
Plan Sets •
4
Plan Check submitted
f
Item ~'�
1 Amount
Structural Calcs.
: "
.
Reviewed, ready for corrections
_
.Plan•.Check Deposit's
'Truss Cales. , t
Called Contact'Person
Plan Check Balance
?`
Energy CaICS.t
Plans picked'up r
Constructions a
rjpT 6
Floodplain plan
1
Plans resubmitted'
Mechanical
•
'Grading, , lan:
g P.. �
= '
2"a Review, ready for correctio issue
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Electrical r ,
Subcontactor List
Called Contact Person W. G
Plumbing.
Grant Deed
Plans picked up
S.M.I.. 1
LA -'
H.O.A. Approval `
Plans resubmitted `'
' r•
Grading .,�,.
IN HOUSE:- T .
,"
'"' Review, ready for corrections/issue
Developer Impact Fee-
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PlanningApproval�t
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Pub. Wks. Appr
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Total Permit Fees , . „Li
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JOHNSON AND NIELSEN ASSOCIATES 1 r p 4 JOB. N0. O -
CONSULTING STRUCTURAL ENGINEERSV
" � IA T&Y90BY I r r
647 N. MAIN STREET, SUITE 4:-B1� I d DATEA' �4
RIVERSIDE, CALIFORNIA 92501 -
900-686-5122 FAX 909-686-6752 SH --L,_ OF
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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