RER (12-0185)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
12-00000185
Property Address:
56100 MUIRFIELD VILLAGE
APN:
762-400-004- - -
Application description:
REMODEL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
50000
Applicant: Architect or Engineer:
0 --
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LICENSED
CONTRACTOR'S DECLARATION
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT' A 11
�JUI
�J re 3/14/12 !
Owner. x
FREEZE NANCY S 1 (s'R ,IL :4 z092
56100 MUIRFIELD ;?VI LAGE !f i
LA QUINTA, CA 9253
CITY F-- _
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 Professionals Code, and my License is in full force and effect.
cense Class: 13 License No.: 769229
Date: S I I Contractor:
OWNER -BUILDER DECLARATION
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).:
(_ 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
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.).
(_) 1, 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 contractors) 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
LQPERnIIT
Contractor:
ALBERS CONSTRUCTION CO, INC.
P.O. BOX 238
LA QUINTA, CA 92253
(760)771-9954
Lic. No.: 769229
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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 of the work for which this permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier STATE FUND Policy Number 0004885-2011
_ 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 e, 1 shall fort ith mply with those provisions.
of
late: a plicant:
WARNING: FAILURE TO SECURE WORKERS' OM PEN SATION 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 permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that 1 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 �RSignature
upon the above-mentioned grope or inspectio os
//ate: (Applicant or Agent):
Application Number . . . . . 12-00000185
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee
414.50 Plan Check Fee
269.43
Issue Date . .
Valuation . . .
. 50000
Expiration Date
9/10/12
Qty Unit Charge
Per
Extension
BASE FEE
252.00
25.00 6.5000
----------------------------------------------------------------------------
THOU BLDG 25,001-50,000
162.50
Permit . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
19.50 Plan Check Fee
4.88
Issue Date . . . .
Valuation
0
Expiration Date
9/10/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
6.00 .7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
4.50
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
30.00 Plan Check Fee
7.50
Issue Date . . . .
Valuation . . .
. 0
Expiration Date
9/10/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 6.0000
EA PLB FIXTURE
6.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
2.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
6.00
----------------------------------------------------------------------------
Special Notes and Comments
EXTERIOR MASONRY FIREPLACE
(ISOKERN) W/
GAS INSERT; GAS BBQ GRILL W/ ELECT.; WET
BAR SINK / COUNTER W/
ELECT. GFI
RECEPTACLES REQUIRED.
2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
2.00
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total
464.00 .00 .00
464.00
Plan Check Total
281.81 .00 .00
281.81
Other Fee Total
2.00 .00 .00
2.00
LQPEMNIIT
Application Number . . . . . 12-00000185
Grand Total 747.81 .00
LQPERMIT
00 747.81
Bin f..
ty, Of
= Ci� i `l'�ulttd
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'P.O.tox.1504,:78-495.CalkTampico.
La.Qlkita, CA 92253 -:(760) 777,7012..
Building Permit Applicatlon'and Tracking Sheet
Permit`# a%
v
ProjectAdd=: S U O ih V 1 VI's
Owner's Name:. G• ! �i?-t
A. P. Number.
Address: ' : Sig. l W. . Mv, i1 F, LsL6 V(L(JoL
.
Legal Description:
City, ST, Zip: �— (�✓ • ,
/n
Contractor A -L- 6 eiLS C" Smu-c'[l o,) lD
Telephone: S V 221 > v lIJ
Address: L' q pS� : 2�t na.�n S�t� t
Project Description:
City, ST, Zip: V I N t -2.N °12zS 3
C dU(L'i Y/�rtp Il fw� ,fl L
Telephone: '`7 d0 -7•7 q p:�."4City
Lic. #: % b 22 �( B;
Ilgl�tS cih►State
•-- '1 2�p.uYz, it b ANr�} c ti
Arch, Bngr., Designee tA U IA&L-f � nil
' 1'..�tfi &441 MLL-I
Address: 522ti 3 �v t o
N eW .39 teK PAVE:
City., ST. Zap: n
Telephone: -244 93S.', ( p 35 -9 Construction Type: , Oce upanq:
Steck Lic. #: Project type (cucle one): New Add'a Alter Repair Demo
Name of Contact Person: c �) �,�� Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: 71p o .'7'7 y 9-')g ^7 Estimated Value of Project
APPLICANT: DO NOT WRITE BELOW THIS. LINE
M
Submittal
Plan Sets
Req'd
Recd
19
TRACH NG PERhIITTMS
Plan Geek submitted Amount
a
Reviewed, ready for corrections Pian Check Deposit. .
Nass Cates.
Called Contact Person Pian Check lWance
Title 24 Cates.
Plans picked up Construetlou
Flood plain pian
Plans resubmitted.. Mecharded
Giading plan
2`! Review, ready for correctio issue eetrical .
Snbcontactor List
Called Contact Person umbing
Grant Deed
Plans picked up SJAJL
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE-
3" Review; ready for correction s/issae • - Developer Impact Fee
Planning Approval
Called Contact Person AXP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees , 8