04-7474 (RER)�4U BUILDING & SAFETY DEPARTMENT
C -ice`v4�lNP.O. Box 1504(760):777-7012
=OF'T�9 E� 784.95 CALLE TAMPICO FAX (760) 777770111
LA QUINTA, CALIFORNIA 92253' INSPECTION REQUESTS (760)-777-7.153
BUILDING PERMIT
Application Number °04-0.0007474-( Date 12/14/04
Property Address 48225 VIA SOLANA
APN: 6,46-380-063- - -
Application description;. REMODEL - RESIDENTIAL
Property Zoning . . . . LOW DENSITY.RESIDENTIAL.
Application valuation 30000
Owner 'Contra'ctor
RON STILL. TRI STAR CONTRACTING;.'INC.
48225 VIA SOLANA P.O. BOX 542
LA QUINTA CA `92253 CATHEDRAL IC•ITY CA 92234
(7.60) ;321-0898
WCC: STATE.FUND
WC: 0440019798 10/01/05
CSLB: 475515 01/31/05
CCC:✓ A -B
--- Structure Information PATIO`REMODEL GAS BBQ: FATER FEATURE .----
Construction Type TYPE V - NON RATED
Occupancy Type DWELLG/LODGING/LONG <=10
Flood Zone . . . . . NON -AO FLOOD ZONE
Other struct info CODE EDITION 2001 CBC
Permit BUILDING PERMIT
Additional desc
Permit Fee 284.50, Plan Check, -Fee 1,84.93
Issue•,Date Valuation` X30000
Qty Unit Charge Per Extension
BASE FEE 252.00
5.00 6.5000 THOU BLDG 25,001-50,00'0...., 32.50
Permit . . . . ELECT ADD/ALT/REM:`
Additional desc
Permit Fee. 18.75 Plan Check Fee.. ,4.69
Issue'Date . . Valuation. . . 0
Qty 'Unit. Charge Per Extension
BASE .FEE 15.00
1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20• .75
1.003. 000 EA ELEC APPLIANCES 3.00
Permit 'PLUMB.ING
Additional desc
Permit Fee 27-00 Plan Check.Fee 6.75
Issue Date . . ;. Valuation 0
Qty Unit Charge Per Extension.
P.O. BOX 1504 ut4t ot
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: d
Applicant:
Applicant's Mailing Address:
Date: / Z' /
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I a 5unpisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License is i II force and ct.
License Class o.
Date Z Contractor
N� OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's' 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' State 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
}}��ss��e��,, My wQ�vers' corflpPnsation insurance carrier and poli y er re: ��
Carrier!50_ ( f f/yt/l� Policy Number "n I C1
_ I certify that, in the performanc �rl.' he workor ich this rmit s issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation law a ifomiand agre at, if 1 sho d become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith complyw those pr ions.
Date Z— Applicant NN
WARNING: FAILURE TO SECURE WORKERS' COMPEN%ON 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
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 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 b ' pe ed under or following issuance of this permit.
2. Any permit issued as a result of this application beco II and void if rk is not co enced within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject pe canc ation.
I certify that I have read this application and state that th above i rmation is ect. I agree t mply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this unt o enter upon a above -m oned property for inspection purposes.
Date Signature (Applicant or Agent)
Page 2
Applicat"ion-Number 04-00007474
Date 12/14/04
Qty Unit Charge "Per'.Extension
BASE " FEE
15:0.0
1:00 6.0000 EA. PLB FIXTURE
6.0,0
1.00' " 3..'0000 EA PLB. WATER INST/ALT/REP
3.00
1.00` 3.0000 EA PLB.GAS PIPE 1-4 OUTLETS
r
3.00
----------------------------------'-------------------
Special* Notes and Comments'
ADD BBQ ,SINK AND LANDSCAPING TO REAR _
PATIO. 12/14/04 8:30:09 AM JJOHNSON
-Other Fees ENERGY REVIEW FEE"
18.,49
Fee zummary Charged Paid_ Credited ..,
Due
Permit',Fee.Total 330.25" 00 -:00
330.25
Plan Check Total 1.96, 37 00 .00 .
196..37
Other Fee Total .18.49*..00 .00
18:49
Grand Total545.11 .00 .00'
545.11
SINK [DA
Y OF LA QUINTA
DING & SAFETY DEPT.
FHP APPROVED
-MODEL # SS804BX OR CONSTRUCTION
SINGLE BOWL 1Z l sY
25x22
SATIN FINISH
` 8" DEPTH ' "AN ADEQUATELY SIZED DEBRIS CONTAINER
IS REQUIRED ON THE JOB SITE DURING ALL.
PHASE&OF CONSTRUCTION AND MUST BE
EMPTIED AS NECESSARY. FAILURE TO DO SO
REFRIGERATOR MAY CAUSE THE CITY TO HAVE THE CONTAINER
• DUMPED AT THE EXPENSE OF THE OWNER/
TO BE CHOSEN BY OWNER' k "CONTRACTOR."
DIMENSIONS: 24x34 1 /2x20
k
r orS30
BARBEQUE WUVE00,gDfF7HEAPPRK0
FLANS AND In CARD ARE NOT; ON
. 'SHE SITE OR A ' SCHEDULED • .F
TO BE MOUNTED AS PERMANENT DROP-IN MO#)ffECTION.Demon
'
NATURAL GAS_ APPLICATION NO
Conftcfion Is NOY HMO
on the following Code Holidays:':, • =
M a JltumON HOURS
• r r ',1 t _
i
New Year's Day er 1st - April 30
a ' ' Mo day - Friday: 7:00 a.m. to 5�0 P.M
" Dr. Martin Luther ling Jr.•Day A - _ -
r `r, " Saturday: 8:00 a.m. to 5:00 pm. '
President's Day
Memorial Da . ,,000 BTu �r Sunday: None;
Day Government Code HoHdayas None
Independence D'ay o ' 815 sq in total coowng area ■ Four cast brass burners ■ Porc sin �`�,
coowng surface? Electronic ignition ■ 83212 B �. iten*q 30th .,
I !nor L��1! ? ' brass Insert ■Tank soldseparately ■ #83242 Monday - Friday: 6:00 a.m. to 7:00 pm•
Available in Natural gas Cd lP CrSatarday am. �S:Qo p '
w Sunday: None
,> = Government Code Holidays: Nose
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