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06-1129 (SOTB)4 P.O.' BOX 1504 VOICE (760) 777-7012' . 78-495 CALLE TAMPICO FAX (760) 777-7011 LA. QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7.153 BUILDING PERMIT Date: 3/20/06 Application Number:06=00001129` Owner: Property Address: 81244 VICTORIA LN HUMPHREYS APN: 764-270-999-137 -300234- 51-244 VICTORIA LANE Application description: STRUCTURES OTHER. THAN BUILDINGS LA QUINTA, CA 92253 Property Zoning`: MEDIUM HIGH DENSITY RES Application valuation: 950 Contractor: Applicant: Architect or Engineer: TOPMAN BUILDERS P.O. BOX 10202 O d PALM DESERT, CA 92255 ` (760)772-7296 l�7 w //�� Lic. No.': 455121 4%0 J • �i�y Zpp6 LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLA��A ION ��' - I hereby affirm under penalty of perjury that I a sed 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 a Profe i naIs C. and my License is in full force and effect. _ I have and will maintain a certificate of consent to self-insure for workers' compensatio s rovided - - License Class: B C29 C53 License No.: 455121 - for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ' issued. D '� ontractor: -- - 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 �ae NER-BUILDER DECLARATION - - insurance carrier and policy number are: - -I hereby affirm under penalty of perjury thmpt from the Contractor's State License Law for the ' Carrier CLARENDON Policy Number 01KR-0030-842 following reason (Sec. 7031.5, Business asions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I 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 - and agree that, 4hdo su •ect 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 Lall rt ith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by D��A any applicant for a permit subjects the applicant to a civil penalty" of not more than five hundred dollars ($500).: te. ppIicant,_ (_) 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 WARNING: FAILURE TO SECU'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does. not apply to art owner of property who buildsor improves thereon, SUBJECT AN EMPLOYER TO CLTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANDand who does the work himself.or herself through his or her own employees, provided thatthe - - DOLLARS ($100,000). IN ADDCOST 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 LABOREST, AND ATTORNEY'S FEES. 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.). - - - - APPLICANT ACKNOWLEDGEMENT 1,-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 contractor(s) licensed I . Each person upon whose behalf 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, (' 1 I am exempt under 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 Quinta, its officers, agents and employees for any act or omission related to the work being " - - - - - - performed under or following issuance of this permit.- Date: - Owner: - - 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 abo ormation is correct. -I agree to comply with all " - work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building onstr tion, and hereby authorize representatives of this c unty to enter upon the above-mentioned prope y for spa ion purp as. - Lender's Name: ry Date: S�aignature (Applicant or Agentlr' - Lender's Address: - -' - - - - LQPERMIT - Fipplcation Number 06-00001129 Permit BUILDING PERMIT -, Additional desc Permit Fee-'- 25.00 Plan Check Fee 16.25 Issue Valuation . . . 950 _Date Expiration Date .".: 9/16/06: Qty Unit Charge Per: Extension . BASE FEE. 15.00 5.00 2.0000 HND BLDG 501-2,000 10.00 : Permit PLUMBING . - Additional desc . Permit Fee 18.00 Plan Check Fee 4.50 Issue`Date Valuation 0 Expiration Du=e 9/16/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4'OUTLETS 3.00 Special Notes and Comments. FIREPIT ONLY. ---------------------------- Other-Fees ENERGY: REVIEW FEE 1.63 Fee summary Charged Paid Credited Due . Permit Fee Total 43.00 .00 .00 43.0'0 Plan Check Total 20.75 .00 .00 20.75 Other Fee Total 1.63 .00' .06 1.63 Grand. Total 65.38 00 .00 65.38 , ,.:_.LQPERMIT .. .- .': ;..- .. .•• .. ;. - - _. .. Bin # City of La Quints Building 8L Safety Division P.Q. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application 'and Tracking Sheet Permit # 0�-' X 12, 9 Project Address: v\' 'L�{14 L pr L ti Owner's Name:-9,-A4.v on A. P. Number: Address: v1 . TCity, Legal Description: ST, Zip:. L �v t Cpl- G 7-z53 Contractor: b 1Pq-J U ` Telephone: L(ct7 . 21S .-i ,s Address: �-.#jW-j-12L4 CLi/IS � Project Description: City, ST, Zip: �Ar . �' Z L. v l N Telephone--)�, 2y c� ri r, City Lic. #: State Lie. #: rj5 ('j : Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ' " State Lic. #: of Contact Person: Construction Type: Occupancy: Project type (circle one): New Add'n Alter' Repair Demo --TName Sq. Ft.: #Stories: # Units: Telephone # of Contact Person: . `� (pp . Z7rj .. Estimated Value of Project: W39-6, APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING. PERMIT FEES Plan Sets .s Plan Check submitted ? Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction So 7? Flood plain plan Plans resubmitted Mechanical Grading.plan 2"d Review, ready foreorrections/issue Electrical a Subcontactor List Called Contact Person Plumbinge,45 �_,yo�r,Gt�.s Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- ''' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees