10-1301 (AR)81307 Amundson Ave
10-1301
wa .' IIIIIIIIIIIIIIIIIIIIIIIII 01
IE
P.O. BOX 1504 - -
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t! aF4w
BUILDING& SAFETY DEPARTMENT
BUILDING PERMIT
Application. Number:
10-00001301
Owner:
Property Address:
81307 AMUNDSEN AVE
MICHAEL H GRAY TRUST
APN:
767-690-020- - -
PO BOX 9935
Application description:
ADDITION - RESIDENTIAL
NEWPORT BEACH, CA 9265
9265F
F
Property Zoning:
Property
LOW DENSITY RESIDENTIAL
Application valuation:
23997
Contractor:
Applicant:
Architect or Engineer:
BRADSHAW CONSTRUCTION
N(
t v TO
b/Vr/ lW?I& /
l ,I,
46248 ROUDEL LN
LA QUINTA, CA 92253
/rmfC
42- A 1
(760)347-4246
Lic. No.: 848057
------------------ -------------------------------
L END CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury the am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busines nd Professionals Code, and my License is in full force and effect.
License Class: B ense No.: 848057
Date: e1 _1<-1Z Contractor:
i 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 Contractor's 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).:
(_) 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 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.).
(_) I, 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.).
( •) I am exempt under Sec. , B.&P.C. for this reason
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:
Lender's Address:
LQPER\IIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/30/10
`` 2010 2
----------------------------------------------—
WORKER'S 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 f the work for which this permit is issued. My workers' compensation
insurance carrier and polic number are:
Carrier DELOS INS Policy Number 01DKRM22005875
I certify that, in the perform ce of the work for which this permit is issued, I shall not employ any
person in any manner so to become subject to the workers' compensation laws of California,
and agree that, if I shoul ecome subject.to the workers' compensation provisions of Section
3700 of the Labor Code, shall forthwith comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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. '
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, 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.
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 mit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the a o e information is correct. I agr to comply with all
city and county ordinances and state laws relating to buildin onstruction, and hereby a orize representatives
of this county to /enter upon the above-mentioned property f inspection purpose
Date: Signature (Applicant or Agent)•
Application Number . . . . . 10-0000.1301
Permit . . .
BUILDING PERMIT
-
Additional desc
297 SF ADDTN TO MAID QTRS
Permit Fee . . . .
243.00 Plan Check Fee
157.95
Issue Date
Valuation . . . .
23997
Expiration Date
5/29/11
Qty Unit Charge,
Per
Extension
. BASE FEE
45.00
22.00 9.0000
-----------------=------------------------
THOU BLDG 2,001-25,000
----------------------------------
198.00
Permit
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee
40.35 Plan Check Fee
10.09
Issue Date . . . .
Valuation
0
Expiration Date
5/29/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
20.00 .7500
PER ELEC DEVICE/FIXTURE-1ST 20
15.00
23.00. .4500
-------------------------------------------=--------------------------------
EA ELEC_DEV ICE/FIXTURE >20
10.35
Permit
MECHANICAL
Additional desc .
Permit Fee . . .
37.00 Plan Check Fee
9.25
Issue Date . .
Valuation . . . .
0
Expiration Date
-5/29/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
2.00 4.5000
EA MECH•VENT INST/ DUCT ALT
9.00
2.00 6.5000•EA
----------------------------------------------------------------------------
MECH EXHAUST.HOOD
13.00. "
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
27.00 Plan Check Fee
6.75
Issue Date
Valuation . . . .
0
Expiration Date
5/29/11
Qty Unit.Charge
Per
Extension
BASE FEE
15.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000
EA 'PLB FIXTURE DRAIN/VENT REP/ALT
3.00
2.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
6.00
-----------------------------------------------------------------=----------
Special Notes and Comments
297 SF ADDITION TO MAIDS
QUARTERS.
0
LQPERNIIT
Application Number . . . . . 10-00001301
----------------------------------------------------------------------------
Special Notes and
Comments
REMODEL INCLUDES NEW KITCHEN
TO MAIDS
QUARTERS AND KITCHEN AT GUEST
SUITE.
2007 CODES 2008 ENERGY REF. SUPPLEMENT
TO PERMIT 09-0141.
----------------------------------------------------------------------------
Other Fees . . .
. . . . . .
BLDG STDS ADMIN
(SB1473)
1.00
ENERGY REVIEW
FEE
15.80
STRONG MOTION
(SMI) - RES
2.40
Fee summary
Charged
Paid
--------------------
Credited
----------
Due
-----------------
Permit Fee Total
----------
347.35
.00
.00
347.35
Plan Check Total
184.04
.00
.00
184.04
Other Fee Total
19.20
.00
.00V
19.20
Grand Total
550.59
.00
.00
550.59
LQPER1N4IT