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BRES2015-016951775 Avenida Madero BRES2015-0169 6 78-495 CALLETAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: ETHAN GRANT 5691 MANSRUM DRIVE LA QUINTA, CA 92253 BRES2015-0169 51775 AVENIDA MADERO' 773153013 GRANT/ REMODEL/ KITCH $100,000.00 V, COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury 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. License Class: License No.: 834358 01 Date:) l2 2 Contractor. J 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 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. Q. Lender's Name VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/12/2015 Owner: ETHAN GRANT 5691 MANGRUM DR. HUNTINGTON BEACH, CA 92649 Contractor: JEFFREY F KELLNER PO BOX 6289 BIG BEAR LAKE, CA 92315 (760)774-5333 Llc. No.: 834358 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 th ork for which this permit is issued. have and will maintain workers' compensation insurance, as required by ion 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: Carrier: _ Polity Number: _ _ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the. workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. . Dat > " Applic na L 1 ►7 7L ll 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 Building Official 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 permit, or cessation of work for 180 days will subject permit to cancellation. 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 of this city toe er upon the above- mentioned p operty for inspection purposes. Date: 0 I2 / Signature (Applicant or Agent): Lender's Address: I DESCRIPTION FINANCIAL .• ACCOUNT /. QTY AMOUNT PAID PAID DATE HOURLY PLAN CHECK - YES 101-0000-42600 1.25 $87.50 $87.50 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE HOURLY PLAN CHECK -YES 101-0000-42600 0.75 $52.50 $52.50 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA Total Paid for BLDG CITY STAFF - PER HOUR: $140.00 $140.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $4.00 $4.00 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $4.00 $4.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $12.33 $12.33 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $5.08 $5.08 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $145.03 $145.03 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47.86 $47.86 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA Total Paid for ELECTRICAL - NEW CONSTRUCTION: $210.30 $210.30 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE APPLIANCE REPAIR/ALTERATION 101-0000-42402 0 $12.09 $12.09 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE APPLIANCE REPAIR/ALTERATION PC 101-0000-42600 0 $4.83 $4.83 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK 117003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD 101-0000-42402 0 $12.09 $12.09 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD PC 101-0000-42600 0 $4.83 $4.83 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD'BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE VENT FAN 101-0000-42402 0 $12.09 $12.09 6/12/15 PAID BY METHOD RECEIPT # CHECK # . CLTD BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT.. QTY AMOUNT PAID PAID DATE VENT FAN PC 101-0000-42600 0 $4.83 $4.83 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA Total Paid for MECHANICAL: $50.76 $50.76 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE REMODEL, EA ADDITIONAL 500 SF 101-0000-42400 0 $65.25 $65.25 6/12/15 PAID BY METHOD , RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE REMODEL, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $52.20 $52.20 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE REMODEL, FIRST 100 SF 101-0000-42400 0 $49.31 $49.31 6/12/15 PAID BY METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE REMODEL, FIRST 500 SF PC 101-0000-42600 0 $134.88 $134.88 6/12/15 PAID BY METHOD ' RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA Total Paid for REMODEL: $301.64 $301.64 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $13.00 $13.00 6/12/15 _ PAID BY . METHOD RECEIPT # CHECK # CLTD BY ETHAN GRANT CHECK R7003 471 AZA Total Paid forSTRONG MOTION INSTRUMENTATION SMI $13.00 $13.00 • • Description: GRANT/ REMODEL / KITCHEN AND DEN Type: BUILDING, RESIDENTIAL Subtype: REMODEL Status: ISSUED Applied: 4/27/2015 SKH Approved: 6/3/2015 JJO Parcel No: 773153013 Site Address: 51775 AVENIDA MADERO LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 30 Lot: 1 Issued: 6/12/2015 AZA UNIT 2 Lot Sq Ft.' 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $100,000.00 Occupancy Type: Construction Type: Expired: 12/9/2015 AZA No. Buildings: 0 No. Stories: 0 No. Unites: 0 CHRONOLOGY TYPE Details: NEEDS GRANT DEED, OWNERSHIP DOESN'T SHOW UP AS OWNER ON APPLICATION. RENOVATION OF KITCHEN DEN, REWORK ELEC SERVICE, NEW WINDOWS DOORS, NEW FLOORING TILE STRUC SUPORT FOR CEILINGS . nNN icu w nNNi-- Approved to Issued Printed: Friday, June 12, 2015 1:02:34 PM 1 of 4 sysrrnns ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES NOTE JIM JOHNSON 5/12/2015 6/3/2015 PENDING STRUC CORRECTIONS PLAN CHECK COMMENTS FROM CONSULTANT AJ ORTEGA 6/1/2015 6/1/2015 STRUCTURAL PLAN CHECK COMMENTS CAME BACK APPROVED - PLANS SET ON REVIEWERS DESK. RECEIVED PLAN CHECK.COMMENTS FROM CONSULTANT JIM JOHNSON 5/12/2015 .5/12/2015 CORRECTIONS REQUIRED RECEIVED PLAN CHECK PICKED UP STEPHANIE KHATAMI 5/12/2015 5/12/2015 PICKED UP BY ARMIN PLAN CHECK SUBMITTAL STEPHANIE KHATAMI 4/27/2015 4/28/2015 RECEIVED PLAN CHECK SUBMITTAL STEPHANIE KHATAMI 5/18/2015 5/18/2015 RECEIVED Printed: Friday, June 12, 2015 1:02:34 PM 1 of 4 sysrrnns TELEPHONE CALL 11M JOHNSON 5/12/2015 5/12/2015 CALLED AA DESIGN TO INFORM THEM THEY HAVE CORRECTIONS TELEPHONE CALL JIM JOHNSON 6/3/2015 6/3/2015 CALLED AA DESIGN TO INFORM HIM THAT PLANS ARE READY TO ISSUE, ITEMS NEEDED ARE GRANT DEED, OWNER DOES NOT MATCH APPLICATION. CLTD DESCRIPTION ACCOUNT QTY NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT ETHAN GRANT 5691 MANSRUM DRIVE LA QUINTA CA 92253 (760)774-5333 CONTRACTOR JEFFREY F KELLNER PO BOX 6289 BIG BEAR LAKE CA 92315 (760)774-5333 1.25 $87.50 $87.50 OWNER ETHAN GRANT 5691 MANGRUM DR. HUNTINGTON CA BEACH 92649 (760)774-5333 AZA YES Printed: Friday; lune 12, 2015 1:02:34 PM 2 of 4 CfflAff SYSTEMS FINANCIAL INFORMATION CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY HOURLY PLAN CHECK - 101-0000-42600 1.25 $87.50 $87.50 6/12/15 R7003 471 CHECK ETHAN GRANT AZA YES HOURLY PLAN CHECK - 101-0000-42600 0.75 $52.50 $52.50 6/12/15 R7003 471 CHECK ETHAN GRANT AZA YES Total Paid forBLDG CITY STAFF - PER HOUR: $140.00 $140.00 BSAS SB1473 FEE 101-0000-20306---F-O-] $4.00 $4.00 6/12/15 R7003 471 CHECK ETHAN GRANT AZA Total Paid forBUILDING STANDARDS ADMINISTRATION $4.00 $4.00 BSA: RESIDENTIAL, EA 101-0000-42403 0 $12.33 $12.33 6/12/15 R7003 471 CHECK ETHAN GRANT AZA ADDITION 1,000SF RESIDENTIAL, EA 101-0000-42600 0 $5.08 $5.08 6/12/15 R7003 471 CHECK ETHAN GRANT AZA ADDITION 1,000SF, PC RESIDENTIAL, FIRST 101-0000-42403 0 $145.03 $145.03 6/12/15 R7003 471 CHECK ETHAN GRANT AZA 1,0005E Printed: Friday; lune 12, 2015 1:02:34 PM 2 of 4 CfflAff SYSTEMS Printed: Friday, lune 12, 2015 1:02:34 PM 3 of 4 CN? _, SYSTEAAS CLTD DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY RESIDENTIAL, FIRST 101-0000-42600 0 $47.86 $47.86 6/12/15 117003 471 CHECK ETHAN GRANT AZA 1,000SF; PC Total Paid for ELECTRICAL - NEW CONSTRUCTION: $210.30 $210.30 APPLIANCE 101-0000-42402 0 $12.09 $12.09 6/12/15 R7003 471 CHECK ETHAN GRANT AZA. REPAIR/ALTERATION APPLIANCE REPAIR/ALTERATION PC 101-0000-42600 0 $4.83 $4.83 6/12/15 R7003 471 CHECK ETHAN GRANT AZA EXHAUST HOOD 101-0000-42402 .0 $12.09 $12.09 6/12/15 R7003 471 CHECK ETHAN GRANT AZA EXHAUST HOOD PC 101-0000-42600 0 $4.83 $4.83 6/12/15 R7003 471 CHECK ETHAN GRANT AZA VENT FAN 101-0000-42402 0 $12.09 $12.09 6/12/15 R7003 471 CHECK ETHAN GRANT AZA VENT FAN PC 101-0000-42600 0 $4.83 $4.83 6/12/15 R7003 471 CHECK ETHAN GRANT AZA Total Paid forMECHANICAL: $50.76 $50.76 REMODEL, EA 101-0000-42400 0 $65.25 $65.25 6/12/15 R7003 471 CHECK ETHAN GRANT AZA ADDITIONAL 500 SF REMODEL, EA 101-0000-42600 0 $52.20 $52.20 6/12/15 R7003 471 CHECK ETHAN GRANT AZA ADDITIONAL 500 SF PC REMODEL, FIRST 100 SF 101-0000-42400 0 $49.31 $49.31 6/12/15 R7003 471 CHECK ETHAN GRANT AZA REMODEL, FIRST 500 SF 101-0000-42600 0 $134.88 $134.88 6/12/15 R7003 471 CHECK ETHAN GRANT AZA PC Total Paid for REMODEL: $301.64 $301.64 SMI - RESIDENTIAL 101-0000-20308 0 $13.00 $13.00 6/12/15 R7003 471 CHECK ETHAN GRANT AZA._ Total Paid forSTRONG MOTION INSTRUMENTATION SMI $13.00 $13.00 TOTALS:i 0106 Printed: Friday, lune 12, 2015 1:02:34 PM 3 of 4 CN? _, SYSTEAAS Printed: Friday, June 12, 2015 1:02:34 PM 4 of 4 SYSTEMS BOND INFORMATION Attachment Type ATTACHMENTS CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED RETURNED 2ND REVIEW BRES2015-0169 - 2ND REVIEWS STATUS REMARKS 6/1/2015 RE REVIEWER DATE DUE DATE 1 NOTES. TRANSMITTAL . .SENT DATETYPE DATE _ _ NON-STRUCTURAL JIM JOHNSON 4/27/2015 5/11/2015 5/12/2015 REVISIONS REQUIRED 51-775 AVENIDA PENDING STRUC CORRECTIONS YOUNG 4/28/1015 5/11/2015 5/12/2015 REVISIONS REQUIRED MODERO.docx STRUCTURAL 2ND SUBMITTAL - SENT TO YOUNG ENGINEERING 2ND SUBMITTAL - DOC NON-STRUCTURAL - JIM JOHNSON 5/18/2015 6/1/2015 5/27/2015 APPROVED 2 WK COMMENTS 05-19- NON STRUC APPROVED PENDING STRUC COMMENTS 05-19-05 YOUNG 5/18/2015 6/1/2015 6/1/2015 READY FOR APPROVAL STEPHANIE KHATAMI STRUCTURAL 05-18-19 STRUCTURAL - 2 WK 0 19.pdf ENGINEERING Printed: Friday, June 12, 2015 1:02:34 PM 4 of 4 SYSTEMS BOND INFORMATION Attachment Type ATTACHMENTS CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED 2ND REVIEW BRES2015-0169 - 2ND DOC 6/1/2015 AJ ORTEGA STRUCTURAL REVIEW STRUCTURAL 1 TRANSMITTAL TRANSMITTAL (APPROVED) (APPROVED).pdf DOC 5/12/2015 JIM JOHNSON 51-775 AVENIDA 51-77S AVENIDA 0 MODERO.docx MODERO.docx 2ND SUBMITTAL - 2ND SUBMITTAL - DOC 5/19/2015 STEPHANIE KHATAMI CORRECTION LIST AND CORRECTION LIST AND 0 COMMENTS 05-19- COMMENTS 05-19-05 05.pdf DOC 5/19/2015 STEPHANIE KHATAMI STRUCTURAL 05-18-19 STRUCTURAL 05-18- 0 19.pdf Printed: Friday, June 12, 2015 1:02:34 PM 4 of 4 SYSTEMS