12-0933 (RER)P:O. "BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO 1 FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
" Date: 9/05/12
Application Number: 12-00000933 Owner:'
Property Address: 80055 MERION CREIGHTON, SCOTT F.
APN: 762-191-010- - - 80-055 MERION
Application description: REMODEL - RESIDENTIAL • LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: '.11000
Contractor: 112012
Applicant: Architect or Engineer:- 7C' S CONSTRUCTION INV—
48236
48236 VISTA DE NOPAL
LA QUINTA, CA 92A3 CITY OF LA QUINTA.
(760) 564-5811 FINANCE DEPT.
Lica No.: 594043
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LICENSED CONTRACTOR'S DECLARATION • , WORKER'S COMPENSATION DECLARATION
hereby affirm under penalty of perj y th I am licensed 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 Usines and Professionals Code, 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 License No.: 594043 • for by Section-3700 of the Labor Code, for the performance of the work for which this permit is _
_ / issued.
• V Date: ontractor: _ 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 that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 0028211-2011 `
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the perfor of the work for which this permit is issued, I shall not employ any
construct, alter; improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner o as t become subject 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, if, I s ould be ome subject to 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 Labor ode, I all fo ith comply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by _ �) „1)
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: /Dale: 1 1i Applicant: '
(_ 1 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 WARNING: FAILURE TO SECURE ORKE COMPENSATION 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 CRIMINAL P ALTIES 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
(_) 1, 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,
(_ 1 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
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.
Date: Owner: 2. Any permit issued as a result of this application becomes null and void if work is not commenced
.. within 160 days from date of issuance.of such permit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to cancellation.
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the ' I certify that I have read this application and state that th bove formation is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to bui ing co tructi,99, and hereby authorize representatives
Z.:
this county to enter pon the above-mentioned prop y for ' specti purposes.
Lender's Name: -
c Date: f' ^ Signature (Applicant or Agent): -
Lender's Address:
LQPERMIT ,
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LQPERMIT
Application Number w . . 12-0000.0933
y ------ Structure Information EXISTING SFD
-=---
" Construction TypeTYPE�V, UNPROTECTED
Occupancy Type . . DWELLG/LODGING/CONG <=10
Other struct info CODE EDITION
2010 ,
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Permit . . .BUILDING PERMIT
Additional desc
Permit Fee x-126.00 Plan Check Fee
81.90
Issue Date Valuation
11000'
Expiration.Date,. 3/04/13 ,
Qty Unit Charge Per
Extension
BASE FEE
45.00 ".
9.00. 9.0000 THOU BLDG 2,001-25,000
81.00 _
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Special Notes and Comments`
'
INTERIOR ENTRY AREA REMODEL; REPLACE
LIVING ROOM SL.GL. DRS. PER ENGINEERED
PLANS. ARCHITECT: CHARLES•GARLAND C11991
2010 CODES.
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• Other Fees BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
8.19
HOURLY PLAN CHECK
87.50
` STRONG MOTION (SMI) - RES
1.10 Y
Fee summary Charged Paid Credited
Due .'
Permit Fee Total 126.00 .00 .00
126.00
r Plan Check Total 81.90 .00 .00
81.90
Other Fee Total 97.79 .00 .00
97.79 `
Grand Total 305.69 .00 .00
305.69
e
LQPERMIT