13-0647 (RER)P.O. BOX 1504
78-495 CALLS TAMPICO
LA QUINTA. CALIFORNIA 92253
Application Number: 13-00000647
Property Address: 49803 ADELITO DR
APN: 646-240-014- - -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 5000
Applicant:
Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DONALD BIGLER
49803 ADELITO
LA QUINTA, CA 92253
(251)423-9531
Contractor:
TR CONSTRUCTION
77224 CALLE POTRERO
LA QUINTA, CA 92253
(760)831-1863
Lic. No.: 431792
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/06/13
----___'-'-_,-------------------*-,--•-------------------------
LICENSED CONTRACTOR'S DECLARATION
--
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licermud 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 and nlosstonais ..ol 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 ct3Ins .- 431792
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date:' Contractor:
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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury I am exempt from the Contractor's State License Law for the
Carrier EXEMPT Policy Number EXEMPT
following reason (Sec. 7031 5, Business and Professions Code: Any city or county that requires a permit to
res ILcertify that, in the performance of the work for which this permit is issued, I.ah911 not errtplgy any
_�-ems'
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
person in any mVsobecome l�ct 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, irno suh' Ct ❑ 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 Lah�I forth it! jSly with those 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 ($500).:
Date: J Applicant:1,
as owner of the property, or my employees with wages as their sole compensation, will do the work, and
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECUCOMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO GLTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($ 100,000). IN ADDITION TO 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 LABOR CODE, 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 sale.).
APPLICANT ACKNOWLEDGEMENT
( ) I, 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
1, 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,
( ) 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
Date;
Owner:
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: Vs
/Lender's Address:
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 i]vrmll r cessation of work for 180 days will subject
permit to cancellation -
I certify that I have read this application and state that the almv InlOrrriatl is errpCi. I agree to comply with all
city and county ordinances and state laws relating to building nruractioit zt horeby authorize representatives
of this c 1y to omor upon the abovv�mnntromd pr party f InapecI on z{ ses.
Dale �_� Signnture (Ailpiwant or Agriml.
LQPrRMIT
Application Number . . . . . 13-00000647
Permit REMODEL 2013
Additional desc . .
Permit Fee . . . . 70.07 Plan Check Fee .00
Issue Date . . . . Valuation 0
Expiration Date . . 12/03/13
Qty Unit Charge Per Extension
1.00 48.6200 LS MISC REMODEL, 1ST 100 SF 48.62
1.00 21.4500 EA MISC REMODEL, ADDL 500 SF 21.45
--------------------------------------------- -
Special Notes and Comments
REMODEL GARAGE ADD DRYWALL TO CEILING
2010 CODE
June 6, 2013 9:15:49 AM jjohnson.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
PLAN CHECK, REMODEL 150.15
Fee summary. Charged
Permit Fee Total 70.07
Plan Check Total .00
Other Fee Total 151.15
Grand Total 221.22
Paid Credited Due
.00 .00 70.07
.00 .00 .00
.00 .00 151.15
_00 .00 221.22
LQPERMIT
�cC�tIV�D
MAY 2013 '
Bin # City Of La Quin' to CITY OF Lq - Urry rA
Buifdmg u Safety DhWon COMMUNITY DEI ELOPMENT
Permit # P.O. Box 1504,78-495 Caffe Tampico
n J� fa.Qumta, CA 92253 - (760) 777-7012
Building Permit Application -and Tracking Sheet
Project Address: A/g p? ADQ Owner's Name: D,-&) u F Ie, o,LG2
A. P. Number. Address:
Legal Description: City, ST, Zip: A QUa
Contractor .%Z-, 00'A.J �IO/N Telephone: '25(` Naz- g6?,11now
+--
Address: 77 Z?� d 4LL&—r AIL �b Project Description: Cop-pJJ-4�e PG ! L-rJ$
City,ST,Zip: 1-4ouIIC-. n-- Aci-CI ZY /O eJC-J1a-,& J641- 2-J/4C)','
Telephone: 7 - 1- 679 DtAIW 4v# W'14-4 AJ1- 111a+ gLm g5,� .
State Lie, # : Z City Lie, #t /P Y� �� f.�.-CSC- �-t � IL a �. L- y �
Arch , fingr., Designer. s 1 F G+ , L t .s
Address: A�y�ac—l�l Pow -
City, ST, Zip:
Telephone: Construction Type: Occupancy:
State Lic. #: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: /21 Jlrm Sq. Ft: �-IM l # Stories: f # Units;
Telephone # of Contact Person: 766 - ',�j 1 -1 g63 EW=tcd Value of Pmjc,, cc) , c e
APPLICANT: DO NOT WRITE BELOW THIS LINE
M Submittal
Req'd Reed
Sets
t�Plan
Structural CRIes.
Truss Cales.
Title 24 Calm
Flood plain plan
Grading plan
Sabcontactor List
s
_ iA -
�t3R �L
M
OF
UPHO14EW 15 •�]
W% ME,S,$1
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Z
TRACENG
Plea Check submitted
Reviewed, ready for correction
Called Contact Parson
Plans picked up
Plans resubmitted
Idy for correctionsfisaue
torrections/issae
son
ie
TV (�6U Er
PERMIT FEES
Ihsu
Plan Check Deposit
Plan Check Balance-
Canatmcdon
Mechanical
Electrical
Plnmbing
S.M.I.
Grading
Developer Impact Fee
A.LP.P.
Total Permit Fees
N660
Amount
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