RER (11-1133)54775 Avenida Madero
11-1133
P. BOX 1504 1VIN W VOICE (760) 777-7012
Tii!t 4
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/14/11
Application Number: 11-00001133 Owner:
Property Address: .54775 AVENIDA MADERO EMPEY CHAD K/MILLER RAE L
APN: .774-264-022-11 -000000 54775 AVENIDA MADERO
Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 3200 1
0
0
Contractor: 1
Applicant: Architect or Engineer: TR CONSTRUCTIONI'I t r
77224 CALLE POTRERO.f 01Pp y
LA QUINTA, CA 92253 y1.4-2011
14A,(760) 831-1863 ! CITYOFt-4 JINTA
•.— Lic. No.: 431792.rtF,a-='> K pT
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 Busines nd Professionals Code, and my License is in full force and effect.
License Class: 13 cense No.: 431792
Date: 0--141- ((Contractor:
0NER-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 Lawdoes 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 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. C.).
Lender's Name:
Lender's Address:
LQPERMIT -
WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perjury one of the folldwing 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 of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are: ,
Carrier EXEMPT Policy Number EXEMPT
_ 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 o become subject to the workers' compensation laws of California, "
and agree that, if, I hould me su 'ect t the workers' compensation provisions of Section
3700 of the Labor shall fo with o ply with those provisions.
Date: /b-/ f- P I.APPlicant:'
WARNING: FAILURE TO SECURE W RIKERS 'COIP'ENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI AL 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 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 abo -_format' n's correct. I agree to comply with all
city and county ordinances and state laws relating to __strut[: , nd hereby authorize representatives
of this county to enter upon the above-mentioned prop y r inspect: rposes.
Date: 1&gignature (Applicant or Agent): _
Application Number . . . . 11-00001133
------ Structure Information DEMO/REMODEL
-----
Other struct info . . . . . CODE EDITION
2010
Permit ." . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 63.00 Plan Check
-Fee
40.95
Issue Date . . . . Valuation
3200`
Expiration Date 4/il/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00 9.0000 THOU BLDG 2,001-25,000
18.00•
------------------------=------------------------='--------------------------
Special Notes and Comments
REMOVE EXISTING PATIO ENCLOSURES AND
DEMO 200SF OF EXISTING PATIO COVER -
REFRAME AND REPAIR CONNECTIONS AREAS AS
NECESSARY. 2010 CALIFORNIA BUILDING
CODES.
October 14, 2011 2:04:41 PM AORTEGA
------------------------------------------------------------
Other Fees . . .. . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 63.00. .00
.00
63.00
Plan Check Total 40.95:. . .00:
.00
40.95
Other Fee Total 1.00 .00
.00
1.00
Grand Total 104.95 .00
.00
104.95
LQPERMIT
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Building llt Safety Dlvlsion
Permit #
P.O. Box 1504,78-495 Calk Tampico
la.Quinta, CA 92253- (760) 777-7012
Building Permit Application and Tracking Sheet
ProjectAddress: _7 S' Owner's Name: Q ' yM e •
A. P. Number.113
Address: '
Legal Description:
City, ST, Zip: LA U; M114 ZZ
Contractor. '7'(Z, j QUt= /[)IL) Telephone:'76c) 97070/9
Address: '7722(SII r rte. Project Description: ;)4j-;0 P-e-model—
City, ST, Zip: L4 01U'L/4-
eK Wt
Telephone: 766 .
State Lia #: 3I 2. City Lia #: 10q739
Arch., Eagr., Designer. 1 e"o 14 Y.: V ?00 L . t eUV IEjiI J
Address:
City, ST, Zip:
Telephone: Construction Type:. pcciipz! cq:
State Lia #:
Project type (circle one): New Add'n Alter Repair Demo
1
.
Name of Contact Person
Sq. Ft.:. # Stories: # Units:
Telephone # of Contact Penson: Estimated Value of Project: ;00
APPLICANT: DO NOT.WRITE BELOW THIS LINE•
N Submittal Req'd Recd 7 TRACMG 'PERMIT FEES
Plan Set Plaa Check submitted It= Amount:.
Stractaral Cities.
Reviewed, ready for corrections
Plan Cheek Deposit:
Truss Cans.
Called Contact Person
Plan Ctteck.Salance± ;
Title 24 Calci.
Plans picked up
Conatraeaan jq6V '; V
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
VReview, ready for correctionsrtssut
Electrical
Subtoataetor List
,Called Contact Person
Plum btag
Grant Dem
Plans picked up
S bLI:
H.O.A. Approval
Plans resubmitted
Grading
Review, ready for tormcdonsRssut
Developer Impart Fee
PU Lnlag Approve
Called Contact Person
A I P.Y.
Pub. Wks. Appr
Date of ptrmit issue
School Feu
Total Permit Fees