05-0817 (RER)1
P.O. Box 1504
78-495 CALLE TAMPICO
A QUINTA, CALIFORNIA 92253
BUILDING PERMIT
BUILDING & SAFETY DEPARTMENT
(760),777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
c,F "p�prication Number .
. . . .. OS -0000_0817 Date
3/21/05
Property.Address
78495 -VIA SEVILLA
APN:
604-212-010-54 -23971
Application description
. . . REMODEL —RESIDENTIAL
Property Zoning
LOW DENSITY -RESIDENTIAL
Application valuation
3000,
Owner
Contractor
--------- ---------------
------------
------- --JIM
JIMPOPE
LEE CONSTRUCTION, MICHAEL
78495 VIA SEVILLA
53930 AVENIDA MADERO
LA QUINTA
CA 92253 LA QUINTA CA
92253
(760) 333-8690
WCC: EXEMPT
WC:. EXEMPT
06/30/05
CSLB:. 602947
02/2.8/07
CCC: C53
,,.
Structure Information ---------------------
Construction Type . .
. . . TYPE III - NON RATED
Flood Zone . . . . .
. . . NON -AO FLOOD ZONE
Other struct info . .
. . . CODE EDITION 2001
# BEDROOMS
.00
------------------------------------------------------------------------------
Permit
BUILDING PERMIT
Additional desc
Permit Fee . . . .
54.00' Plan' Check' Fee
35.10
Issue Date. . . . .
Valuation . . .
3000
Qty. Unit Charge
Per. -
Extension
BASE FEE
45.00
1.00 9.0000
THOU BLDG 2,001=25,000"
9.00
Permit . . ...
MECHANICAL
Additional desc
Permit Fee
21.50 Plan Check. Fee
6.50
Issue Date . . . .
Valuation . . . .
0
Qty Unit Charge
Per As
Extension
BASE FEE:.
15.00
.00 11.0000
EA MECH DOMESTIC INCINERATOR
.00
1.00 6.5000
EA MECH OTHER MECH EQUIPMENT
6.50
Special Notes and Comments
FREESTANDING WOOD -BURNING FIREPLACE IN
BACKYARD. 2001 CODES
-----------------------------------------------.------------------------------
_.
Other Fees . . .
. . ... --HOURLY PLAN CHECK
26`.25
STRONG MOTION (SMI) - RES
.50
P.O. BOX 1504• f 4 4 ��I ��i
r1/ VOICE (760) 777-7012
78-495 CALLE TAMPICO TFAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0,5-451-7 Date: 3 -�l • ® 5
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
AJA
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
Co e, and_my License 's in full force and effect. /^ q
nse Class _ -1; 3 ,cense No. � / V 7
OWNER -BUILDER DECLARATION
1 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 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 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 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'. Slate License 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:
_ 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.
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 insurance carrier and policy number are:
Cartier Policy Number
I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner 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
Lender's Address t4) ,A
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 permit, or
cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct. I agree 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- oned property for inspection purposes.
ate 2 / S' �aturepplicant or Ag
Page , •G:.- : 2
Application Number
05-000008.17
Date 3/21/05
Fee summary
Charged
'Paid
Credited
Due'
-----------------.
' Permit Fee Total
-----------
75.50
----------
.00'
-----------
00
75.50.
' Plan Check Total
41.60-
.00
.100
41.60
Other Fee Total
26.75
.00.
..00
26.75
Grand Total
143.85
.00
00.
143.85.
r
t
f
.
MWIM
Permit # I
Project Address: 7
A. P. Number:
.Legal Description:
Contractor:
Address: S,3 — 3 D e -
City, ST, Zip:. A.
Telephone: d
State Lic. # : 6b2q�7
Arch., Engr., Designer:
Address:
City,, ST, Zip:
Telephone:
State Lic. •
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs:
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
City of La Quinta,
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) '777-7012
Building Permit Application and Tracking Sheet
t Pv/' lL Owner's Name:
wi O .e
Address: -7 9
City, ST, Zip: p
-Cts-i rn �✓L �.�}
Telephone:
�•f eJu Project Description:10 714
�� y G
zzs 3
Lic. #.
Total Permit Fees
Iq
Construction Type: c anc
! Occupancy':
P Y:
Project e
ct cl e on e . New
type (circle r Add'n Alter Repair. Demo
# Stories: # Units:
Estimated Value of Project:-
roject:APPLICANT:
APPLICANT:
DO NOT WRITE BELOW THIS LINE
I
TRACKING
PERMIT FEES
Plan Check submitted
Reviewed, ready for corrections
.3l R
Item
Amount
Plan Check Deposit
Called Contact Person
OPlan Check Balance
Plans picked up
&Construction
Plans resubmitted
Oh'lechanical
2nd Review, ready for corrections ssue21
Called Contact Person
Plans picked up
Ott
Electrical
Plumbing
4S.M:I.
Plans resubmitted
Grading
'`" Review, ready for corrections/issue
Developer Impact Fee
A.I.P.te
lled Contact Person
of permit issue
f
Total Permit Fees
Iq