AR-14-720 (AR)79706 Arnold Palmer
IIIIII I II I I I I IIII 36
T IE --- D VOICE(760)777-7125
78-495 CALLE TAMPICO FAX(760)777-7011
LA QUINTA,CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS(760)777-7153
BUILDING PERMIT
Date: 7/7/2014
Application Number:§NAR.]45720 Owner:
Property Address: 79706 ARNOLD PALMER BILL HOLDER
APN: 775241026 79705 ARNOLD PALMER
Application Description: ATRIUM CONVERSION TO LIBRARY LA QUINTA,CA 92253
Property Zoning:
Application Valuation: $0.00
d1
Applicant: D Contractor:
AGIM RADOM I LARRY COIA JR DBA 7 C'S CONSTR
JUL `o ( 48-236 VISTA DE NOPAL
i LA QUINTA,CA 92253
' Cff f OF LA QUINTA
FINANICE DEPT. (760)564-5811
Llc. No.:594043
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am ' en ed under provisions of Chapter 9 I hereby affirm under penalty of perjury one of the following declarations:
{commencing with Section 7000}of Division 3 the B siness and Professions Code,and _ I have and will maintain a certificate of consent to self-insure for workers'
my License is in full force and effect. compensation,as provided for by Section 3700 of the Labor Code,for the performance of
License Class:B License No.:59404 the work for which this permit is issued.
_ I have and will maintain workers'compensation insurance,as required by
Date: —7.1 ontractor: Section 3700 of the Labor Code,for the performance of the work for which this permit is
issued. My workers'compensation insurance carrier and policy number are:
OWNER-BUIL ER DEC ATION Carrier:_ Policy Number:_
I hereby affirm under penalty of perjury th t f am ex pt from the Contractor's State _ I certify that in the performance of the work for which this permit is issued,I
License Law for the following reason(Sec.7031.5,Business and Professions Code:Any shall not employ any person in any manner so 0 ome sub' ct to the workers'
city or county that requires a permit to construct,alter,improve,demolish,or repair any compensation laws of California,and agree at,if I s ould b e subject to the
structure,prior to its issuance,also requires the applicant for the permit to file a signed workers'compensation provisions of Sec ti n 3700 the L r Code,I shall forthwith
statement that he or she is licensed pursuant to the provisions of the Contractor's State comply with those provisions.
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business i _I
and Professions Code)or that he or she is exempt therefrom and the basis for the alleged te: ( Applicant:
exemption. Any violation of Section 7031.5 by any applicant for a permit subjects th
applicant to a civil penalty of not more than five hundred dollars($500).: WARNING:FAILURE TO SECURE WORKERSCOMPE4ATION COVERAGE IS UNLAWFUL,
(_)I,as owner of the property,or my employees with wages as their sole AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
compensation,will do the work,and the structure is not intended or offered for sale. HUNDRED THOUSAND DOLLARS($100,000). IN ADDITION TO THE COST OF
(Sec.7044,Business and Professions Code:The Contractors'State License Law does not COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon,and who does the work INTEREST,AND ATTORNEY'S FEES.
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 APPLICANT ACKNOWLEDGEMENT
within one year of completion,the owner-builder will have the burden of proving that he IMPORTANT:Application is hereby made to the Building Official for a permit subject to
or she did not build or improve for the purpose of sale.). the conditions and restrictions set forth on this application.
(_)I,as owner of the property,am exclusively contracting with licensed contractors to 1. Each person upon whose behalf this application is made,each person at whose
construct the project. (Sec.7044,Business and Professions Code:The Contractors'State request and for whose benefit work is performed under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon,and as a result of this application,the owner,and the applicant, each agrees to,and shall
who contracts for the projects with a contractor(s)licensed pursuant to the Contractors' defend,indemnify and hold harmless the City of La Quinta,its officers,agents,and
State License Law.). employees for any act or omission related to the work being performed under or
(_)I am exempt under Sec. .B.&P.C.for this reason 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 permit,or cessation of work
Date: Owner: for 180 days will subject permit to cancellation.
CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that thX1
o e information is correct.
I hereby affirm under penalty of perjury that there is a construction lending agency for I agree to comply with all city and county ordinances a stat laws relating to building
the performance of the work for which this permit is issued(Sec.3097,Civ.C.). construction,and hereby authorize representatives o this ci to enter upon the above-
mentioned property for inspection purposes.
Lender's Name:
1 ate: Sig re(Applicant or Ag t)
Lender's Address: /'
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 7/7/14
PAID BY METHOD RECEIPT# CHECK# CLTD BY
LARRY COIA JR DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $1.00
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
DEVICES,FIRST 20 101-0000-42403 0 $23.83 $23.83 7/7/14
PAID BY METHOD RECEIPT# CHECK# CLTD BY
LARRY COIA JR DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid for ELECTRICAL: $23.83 $23.83
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
RESIDENTIAL,EA ADDITION 1,000SF 101-0000-42403 0 $143.00 $143.00 7/7/14
PAID BY METHOD RECEIPT# CHECK# CLTD BY
LARRY COIA JR DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid for ELECTRICAL-NEW CONSTRUCTION: $143.00 $143.00
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
APPLIANCE REPAIR/ALTERATION 101-0000-42402 0 $11.92 $11.92 7/7/14
PAID BY METHOD. RECEIPT# CHECK# CLTD BY
LARRY COIA JR DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid for MECHANICAL: $11.92 $11.92
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
PLAN CHECK,ELECTRICAL 101-0000-42600 $71.02 $71.02 7/7/14
PAID BY METHOD RECEIPT# CHECK# CLTD BY
LARRY COIA JR DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid for PLAN CHECK, ELECTRICAL: $71.02 $71.02
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
PLAN CHECK,MECHANICAL 101-0000-42600 $4.77 $4.77 7/7/14
PAID BY METHOD RECEIPT# CHECK# CLTD BY
LARRY COIA JR DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid for PLAN CHECK,MECHANICAL: $4.77 $4.77
,DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
PLAN CHECK,PLUMBING 101-0000-42600 $11.92 $11.92 7/7/14
PAID BY METHOD RECEIPT# CHECK# CLTDBY
LARRY COIA JR DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid for PLAN CHECK,PLUMBING: $11.92 $11.92
DESCRIPTION ACCOUNTQTY AMOUNT PAID PAID DATE
PLAN CHECK,REMODEL 101-0000-42600 $150.15 $150.15 7/7/14
PAID BY METHOD RECEIPT.# CHECK# CLTD BY
LARRY COIA JR DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid for PLAN CHECK,REMODEL: $150.15 $150.15
DESCRIPTION ACCOUNTQTY ' . T AMOUNT PAID PAID DATE
ROOF DRAIN 101-0000-42401 0 $11.92 $11.92 7/7/14
PAID BY METHOD RECEIPT# CHECK# CLTD BY
LARRY COIA JR DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid for PLUMBING FEES: $11.92 $11.92
. ,DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
REMODEL,EA ADDITIONAL 500 SF 101-0000-42400 0 $21.45 $21.45 7/7/14
PAID BY METHOD RECEIPT# CHECK# CLTD BY
LARRY COIA JR DBA 7 C'S CONSTR CHECK R279 1047 PJU
DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE
REMODEL,FIRST 100 SF 101-0000-42400 0 $48.62 $48.62 7/7/14
PAID BY METHOD RECEIPT# CHECK# CLTD BY
LARRY COIA 1R DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid for REMODEL: $70.07 $70.07
DESCRIPTION ACCOUNT. QTY
AMOUNT PAID PAID DATE
SMI-RESIDENTIAL 101-0000-20308 0 $1.70 $1.70 7/7/14
PAID BY METHOD RECEIPT# CHECK# CLTD BY
LARRY COIA 1R DBA 7 C'S CONSTR CHECK R279 1047 PJU
Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $1.70 $1.70
TOTALS: -