11-0021 (RER)P.O. BOX 1504 (760 �^� VOICE 777-7012
)
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/14/11
Application Number: 11-00000021 Owner:
Property Address: 51200 AVENIDA CARRANZA PERRY KELLY
APN: 773-061-009-14 -000000- .51200 AVENIDA CARRANZA
Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: COVE RESIDENTIAL
Application valuation: 6500
Contractor: u
Applicant: Architect or Engineer: LANDRY, BRAD
874 BORDER #D-16 JAN 1` Lui1
JOSHUA TREE, CA 92252
Cp*�iR��sl 1� (760) 218-0357 Ci&Mte o €, r
N Lic. No.. 816900 'finr
t?EPahfi�
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 Professionals Code, and my License is in full force and effect.
License Class: B C10nse No.: 816900
Date: Contractor:
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 1, 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-buitder 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.).
1 1 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
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 EXEMPT Policy Number EXEMPT
_ 1 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
3,7/00 of the Labor Code, I shall forthwjlb,mpIy with those provisions.
Date:/ l `( ( Applicant:
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 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 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 county to enter upon the above-mentioned property for inspecti n pur
Date: /—/L( toZC LI Signature (Applicant or Agent):
Application Number . . 11-00000021
------ Structure Information 60SF DEMO/WINDOW CHANGEOUT/LIGHTING ALT -----
Other struct info . . . . . CODE EDITION 2010
----------------------------------------------------------------------------
Permit . . . . . BUILDING PERMIT INV FEE
Additional desc.. .
Permit Fee 180.00 Plan Check Fee 58.50
Issue Date. Valuation . . . . 6500
Expiration Date 7/13/11
Qty Unit Charge Per Extension
BASE FEE 90.00
5.00 18.0000 THOU BLDG 2,001-25,000 90.00
----------------------------------------------------------------------------
Permit . .
Additional desc .
Permit Fee . . .
Issue Date . . .
Expiration Date
ELECT - ADD/ALT/REM INV FEE
87.90 Plan Check Fee . .
Valuation .
7/13/11
10.99
0
Qty Unit Charge Per Extension
BASE FEE 30.00
20.00 1.5000 PER ELEC DEVICE/FIXTURE 1ST 20 30.00
31.00 .9000 EA ELEC DEVICE/FIXTURE >20 27.90
------------------------------------------------=---------------------------
Permit .
Additional desc
Permit Fee
Issue Date
Expiration Date
PLUMBING INV FEE
42.00
7/13/11
Plan Check Fee . . .5.25
Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 30.00
1.00 6.0000 EA PLB WATER INST/ALT/REP 6.00
1.00 6.0000 EA PLB GAS PIPE 1-4 OUTLETS 6.00
-=--------7-----------------------------------------------------------------
Special Notes.and Comments
60SF DEMO + RESIDENTIAL REMODEL/VB/RES-3
[CONVENTIONAL] DEMO HALL/PATIO BETWEEN
GARAGE AND RESIDENCE, WINDOW CHANGEOUT
AND NEW LIGHTING THROUGHOUT HOUSE.
***INVESTIGATION FEE ASSESSED PER 2010
CALIFORNIA RESIDENTIAL CODE CHAPTER 1
§108.6 FOR WORK COMMENCING BEFORE PERMIT
ISSUANCE*** 2010 CALIFORNIA BUILDING
LQPERMIT
Application Number
11-00000021
-----------------------------=----------------------------------------------
Special Notes and
Comments
CODES.
January 14, 2011 3:24:42
PM AORTEGA
--------------------------------=--------------------------------------------
Other Fees
. . . .
BLDG STDS ADMIN (SB1473)
1.00
ENERGY.REVIEW
FEE
5.85
Fee summary
Charged
Paid
Credited
Due
Permit Fee Total
309.90
.00
.00
309.90
Plan Check Total
74.74
.00
.00
74.74
Other Fee Total
6.85
.00
.00
6.85
Grand Total
391.49
.00
.00
391.49
LQPEINIIT
Bin #
Permit #P.O.
J
Project ddmss:
o
City of La Quinta
Building 8L Safety Division
Box 1504, 78-495 Calle Tampico
La Qulnta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
c Owner's Name:
A. P. Number:
Address:
4
Legal Description:
City, ST, Zip:
Contractor: oP
Address:
City, ST, Zip:
Telephone: (g(J q, L
L 4
-O
4 o
Z 1
Telephone:
Project Description:
_
State Lic. # : ((o`� O
City Lic.Arch.,
92-
Engr., Designer:Address:
6L �—
t�-
City, ST, Zip:
-7 t_,
Telephone:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter
ep ' Demo
State Lic. #:
Name of Contact Person:
Sq. Ft.: L (�(v�
# Stories: 1 # Units:
Telephone # of Contact Person:
Estimated Value of Project: k,15-00
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item
Amount,
Structural Cates.
Reviewed, ready for corrections Plan Check Deposit
..�+
Truss Cates.
CalledContact Person Plan Check Balance.
�—
Title 24 Cala.
Plans picked up Construction
Flood plain plan
Plans resubmitted Mechanical
'^
Grading plan
2"! Review, ready for correctioaslissue Electrical
�:� 1p,di1q..
Subcoutactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
r'
H.O.A. Approval
Plans resubmitted Grading
.�
IN HOUSE:
''` Review, ready for corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person %y1 A.LP.P.
Pub, Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
1.41
I IR yi40 • &Ire -E IMC44AX I. AVLE u t Mhft ft, nv, wrukk& V64- O&Aft Gk.aa�utot a�S
4
,jo-wJ
j 9