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04-3490 (AR)s CITY C, L A UViA I 1'YYViwuv7 -.- BUILDING &.'SAFETY DEPARTMENT P.O. BOX 1504 (760) 777-7012 OF.T1'9 78-495 CALLS TAMPICOFAX (760) 777-7011 LA QVINTA, CALIFORNIA 92253. "INSPECTION REQUESTS (760)7.77-7153 BUILDING PERMIT Application Number C04=00003490 Date 4/20"/04. Property Address �-5"047 V5 ISTA MONTANA" APN: c--_77"2=260-007-7 -14104 Application description ADDITION —RESIDENTIAL Pxbperty Zoning . . . . . . •VERY LOW DENSITY RES Application valuation 35.060 Owner Contractor ------------------------ ----------.------- ------ HUBBLE WILLIAM F DURRETT CONST, AL 74040 HIGHWAY 111 NO -228- P.O. BOX 3371 PALM' DESERT CA"92260"' PALM DESERT CA 92261. 760). 774--4368 WCC STATE FUND WC: 1744606 09/0"1/04 . CSLB:. 451035:. 01/31/06 CCC: B ----=--------=---"------""-- Structure. "Information " --------=--------"--.------ Construc"t"ion. "Type `'`TYPE V " - "NON- RATED Occupancy Type . . . DWELLG/LODGING/LONG"<=10_ Flood -Zone NON -AO FLOOD"ZONE a Other struct info CODE EDITION 2001 CBC # BEDROOMS 1.00 FLOOD ZONE NO PATIO SQ FTG" 176.00 FIRST FLOOR SQ FTG 572.00 Permit . . . . . . BUILDING'PERMIT _ Additional desc Permit Fee 323.50. Plan Check Fee '14.58 Issue Date . . . .. Valuation 35060 Qty Unit Charge Per Extension BASE FEE 252.00 11.00 •6.5000 THOU' BLDG 25,001-50,000 71.50 .Permi"t ELEC­NEW`;,RESIDENTIAL Additional desc Permit Fee 35.02 Plan Check Fee 60 Issue.Date Valuation . . . 0 Qty Unit" Charge Per Extension -BASE. FEE 15.00 572.00 ..0350 ELEC NEW RES - 1 OR 2'FAMILY 20.02 P.O. BOX 1504 eaVOICE��G�.,N (760) 777-7012 78-495 CALLS TAM►ICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number. Applicant: ' �n�7'Il�-Cfi�/t—" L Gl/1iJ�T7 Applicant's Mailing Address: `T � " 0 7Z&�-7,� 3 3 7, Date: y' 0— Architect or Engineer. . Archit , orUngineer' bdr s: Uc. No. (f BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm under penalty of perjury that 1 am licensedr Provisions Of Chapter 9 (COtmnancing *11hss h section 7000) of Division 3 of the Busine"'Professionals Loense License is in firq fgroe and efEed unde �---- ",F)�r0 -3S C� ' O � •Contractor �//Gfl2✓L�/,7 ,- I hereby affirm under penalty of perjury that 1 am OWNE43U�R DECLARATION citexempt from the Contractors• Stab license Law for the following reason (Sec. 7031.5. Business and Professions Code: Any Y or wutr� tat a Permit b construct attar. knpn'a'e, demolish, or repair any dmxu ra. Prior b Rs issuance, also requires the applicant for the permit b ib a aipned statement that he a she is ioensed pursuant b tlhe provisions of the Cw*acbW Stab Lim= Law (Chapter 9 (cemmencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt ame m an -f od the basis ter the alleged exernptiern. Any violation of Section 7031.5 by any applicant tenia r a pesubjects Bre oppicaM to a dv.1 penalty of not mere than five hundred dollars U I. as owner of the property. or my enpbyees with wages as their sole compensatiot,.wi do the work. and the structure is not Mended or offered for sale (Sec. 7044. Business and Professions Code: The ContreCbts' Stab License Law does not apply to an owner of property who bunds or improves thereon, and who does ft wok himselsold within oner or though his or her own ernpbProvidedyees, ovided tat hthe improvements are not Intended or offered for sale. It. howeyer, the building or improvement is Year 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 iansed contractor b 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 COntiactor(s) icensed pursuant to the Contractors' State License Law.). (..) I am exempt under Sec . B.& P.C. for this reason Date Owner I hereby affirm under penalty of perjury one of the WORKERS COMPENSATION DECLARATION —I have and wil maintain a oertilkate b seffIrwue for workers'. of the work for which this per., is issued canpersation, as provided for by Section 3700 of the Labor Code. forge pertortranoe 1 have and will maintain wokers' oompenmsatiph inscrrance. as required by Section 3700 of the Labor Code, for the performance of the work for which tris penNt is fuly woketgs'--oompensatk carrier rrier and yofic)r 9 mbar re: Policy Number / lJi'Cx !la 6 trfy M _ 1 oerat, innto the peranee of the vrorli fol whmich tus pe it 19 is ed,1 shall not empby any person In any manner so as to become subject b the workers' compensation taws of California, and agnea that, if I sthould to the workers' compensation provisions of Section 3700 of the Labor Code. I shiae WARNING: FAIUIRE TO SECURE WORKS TION COVERAGE IS W AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE Hl1NpREp THOUS DOLLARS ($100.000), IN ADDIT THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND ATTORNEY'S FEES. . I hereby affirm under CONSTRUCTION LENDING AGENCY DAY of Derlu!Y that there • for the performance of the work for which this Permit Is issued (Sec. 3097. Civ. C.). Lendefs N- err— ne 1�� 4yi Lenders. Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application Is hereby made to the Director of BuMng and Safety for a pemdt subject to the conditions and restrictions set forth on this application. I . issued Each Personresulta< s aupon pse plication. �� abon is made, each Pen.on at whose request and for whose benefit work is performed under or pursuant to any pem * as &ppliication. the owner. and the applicant, each agrees to. and shag. defend. indemnity and hold harmless the City of La Oukda, its officers, agents and employees for any act Of omission related to the work being performed under or following issuance of this pentyl 2 Any permit issued as a result Of this application becomes rvA and void it work is not commenced within 100 drlys from date of Issuance of such peen' or cessation of work for 180 days will subject permit b cancepation. I certify that I have read this application and state that the above information I to ad city and count nes and state laws aorsbuction, ani hereby s Wmorite representatives of this county to entp r . »,e;:#,.,..e_. Y� - .-- .- -- - -.. _ iii rebL^9 b nil 1 Page 2 Application Number 04-00003490, Date 4/20/04 Permit GRADING PERMIT Additional desc Permit Fee --15.00 Plan Check -Fee .00 llssue Date Valuation 0 Qty Unit Charge Per Extension. BASE FEE 15.00 Permit MECHANICAL Additional desc Permit° Fee 39,.50: ' Plan Check Fee .00 Issue Date Valuation . . . 0 Qty, Unit Charge Per Extension BASE FEE 15.00' 1.00 9.0000 EA .. MECH FURNANCE <=100K 9.00 1.00 9.0000 EA ': MECH B/C <=3HP/10OK BTU 9.00 1..00 6.5000 EA MECH VENT FAN 6.50. Pe'rmit PLUMBING ------ Additional desc Permit Fee 58,.50. Plan Check Fee .00 Issue Date . . . . Valuation .0 Qty Unit Charge Per Extension BASE FEE. 15.00 4.00 6.0000 EA PLB FIXTURE 24.00 1.00 61.0000.EA .PLB ROOF DRAIN' 6.00 1.00'. 7.5000,•EA PLB WATER HEATER/VENT .7.50 1.00. 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA PLB GAS'PIPE.1-4 OUTLETS'.. 3.00 Special Notes and Comments 572.S.F. FREE-STANDING GUEST HOUSE PER MUP #2003-441'. PLAN CHECK.FEES MANUALLY REDUCED, TO- ACCOUNT FOR .$250 PLAN CHECK DEPOSIT RECEIVED.ON,1/5/04. --------------- Other Fees ART IN PUBLIC PLACES -RES .00 STRONG MOTION (SMI).- RES 3.50' .Fee.summary .` Charged -Paid Credited: 'Due rN Page 3 Application Number • =. .. 04'00003490 . Date 4/20/04 Permit Fee Total•., 471.52i. :00 :00 471:52 Plane Check Total 14. 58 " :,00 .00 14.58 Other Fee Total. '3:.50• �' 00 W :00, 3.50 Grand Total 489.60- • ..00 .00 489.60 I Building Address V k Mailing Address >`I Add Ci & Classif. VMDN 7 -AA) P.O, BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 . 60K �3 a el. lib) 77y- 93C City Lic. # Arcn., tngr., Designer Ad ress Tel. L D Cs 6 R -r Cit Zip State ' LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to 'its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he 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). 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner or property who builds or improves thereon and who does such work himself or through his own employees, provided that such 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 did not build or improve for the purpose of sale.) H I, as owner of the property, am exclusively contracting with licensed contractors to con. struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 0 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I. have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company F71 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip APPLICATION ONLY ILDING: TYPE'CONST. OCC. GRP. '.Number *77 2 - 26, 0 - 0 07 __1 ial Description/ (Or 7 imcit l -4 / Sq. Ft. ' iA No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Li,rne--'�n� FINAL Issued Validat Validat WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE J