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04-7590 (AR)c'QP.O. BOX 1504 VOICE -.760 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA;QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760)'777-7153 BUILDING PERMIT Date: 6/23/05 Application-Number: 04-00007590 � Owner: Property Address: 79317 CALLE `VISTA VERDE' BARBOZA GAIL L APN: 604=392-051-92 -25953 - 79-317 Calle Vista Verde Application description: ADDITION - RESIDENTIAL LA QUINTA .CA 92253 Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 5864 Contractor: Applicant: Architect or Engineer: WAGES INC, R. P 1425 PARK AVENUE REDLANDS, CA 92373 (909)798-3333 �O Lic. No.: 642516 o 10-\ --- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm u er penalty of ry 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 'vision 3 e 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: B License No.: 642516 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is _ /`,Date: ntractor:issued. . RI 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 polic r ber are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier -STATE FUND Polic umber 1614494 fallowing reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to - I certify that, in the perfor ance o th w rk for i 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 o as to c subj t t the work ' 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, if I sl)puld eco ubject o t workers' P.ms. provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 700 of the Labor C , I sh rthwit com ly with t se provisions. 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 1$ 500).: - te:1 Applican . (_ 1 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, andthe structure is not intended or offered for sale (Seca 7044, Business and Professions Code: The WARNING: FAILURE TO SE URE WORKE S' 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 T CRIMINAL E NALTIES 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 (S 100,000). INA DITION 0 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 LABO E,-INTEREST, 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 sate.). - APPLICANT ACKNOWLEDGEMENT () I,. as owner ofthe property, am exclusive) ontracting with licensed contractors to construct the project ISec. IMPORTANT Application is hereby made to the Director of Building and safety for a permit subject to the 7044, Business and Professions Co T Cont tors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. - property who builds'or improves t 'eon, d w o co9acfor the pro'ects with a contractor(s) licensed . 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' Stat License a 1. whose benefit work is performed under or pursuant to any permit issued as a result of this application, 1 am exempt under Sec. .&P . fo t ' rea othe 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 9 q O� performed under or following issuance of this pe i . - iDate:� pG / Ow r. i• 2. Any permit issued as a result of this applicatio becom s null d void if work is not commenced within 180 days from date of issuance of s h permit or c sation o rk for 180 days will.subject CO STRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of peri ry that the' is a construction lending agency for the performance of the I certify that I have read this application and state that t e above-i or tion is orr ct. I agree comply with all work for which this permit is issued (Sec.- Civ. C.). city and county ordinances and state laws relating to b Idin con tr ion, and ere authori representatives of this c un to ter upon he above-mentioned pro for i tion purp ses. . Lender's Name: "� ,. ignature ,(Applicant or A �A Lender's Address: . LQPERMIT Application Number 04-00007590 Structure"'Information BEDROOM ADDITION ,108 SQFT Construction Type TYPE V - NON RATED Occupancy Type . . . . DWELLG/LODGING/CONG <=10 Other struct info . . . . .CODE EDITION 2001 ## BEDROOMS 1.00 1ST FLOOR SQUARE 108.00 ,FOOTAGE Permit . . . BUILDING PERMIT Additional deae .. Permit Fee . . . . 81.00 Plan Check Fee 52.65 Issue Date . . . Valuation . . 5864 -- Expiration Date 12/20/05 Qty Unit Charge Per Extension BASE FEE 45.00 4.00 9.0000 THOU BLDG 2,001-25,000 36.00. — Permit . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 18.75 Plan Check Fee 4.69 Issue Date . . . . Valuation 0 _. Expiration Date 12/20/0.5 Qty'.Unit Charge Per Extension BASE FEE 15.00 5.00 .7500 PER, ELEC DEVICE/FIXTURE 1ST 20 3.75 Permit MECHANICAL Additional desc . Permit Fee . . 19.50 Plan Check Fee 4.88 Issue Date Valuation . . 0 Expiration Date •. 12/20/05: Qty Unit Charge Per Extension BASE FEE 115.00 1.00. 4..5000 EA MECH VENT INST/ DUCT ALT 4.50 Permit GRADING PERMIT Additional desc . Permit Fee -15.00 Plan Check Fee .00 Issue Date Valuation 0 Expiration Date 12/20/05 Qty Unit Charge Per Extension LQPERMIT _ Application Number . . . . 04-00007590 •Permit GRADING.PERMIT'. 7 Qty Unit Charge Per Extension. BASE FEE 15.00 ------------------------------------------------------- Special Notes and Comments -------- Bedroom addition 108 sgft. " Other Fees . . . . . . . . ENERGY REVIEW FEE. 5.27 STRONG MOTION (SMI). - RES .58 Fee summary Charged Paid Credited Due Permit Fee Total 134..25 .'00 00 134.25 Plan Check Total 62.22• .00 .00 .62.22 _ Other Fee Total 5.85 .00 .00 5.85 Grand Total 202.32 .00 .00 202.32 LQPERMIT