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RER-14-837 (RER)78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: RER-14-837 Property Address: 77935 LAGO DR APN: 658270050 Application Description: KITCHEN REMODEL ONLY Property Zoning: Application Valuation: $21,000.00 Applicant: RUBARTH CONSTRUCTION 54275 AVENIDA VELASCO LA QUINTA, CA 92253 D VOICE (760) 777-7125 FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 UILDING PERMIT Date: 8/13/2014 Owner: THOMAS CURTIS AUG 13 2014 CITY OF LA OUINTA COMMUNITY DEVELOPMENT DEPARTMENT 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: B License No.: 948568 Date: �^ 20/ `l' Contractor J\,&, Q"4 eo 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.). (_J 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 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 Na Lender's Add Contractor: RUBARTH CONSTRUCTION 54275 AVENIDA VELASCO LA QUINTA, CA 92253 (760)601-7408 Llc. No.: 948568 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 pr .vided for by Section 3700 of the Labor Code, for the performance of the w ich this permit is issued. I have and will maintain workers' compensation insurance, as required by Sec 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:_ Policy 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. A A Date: rb '-) 3 ^Z 01'-1 Applica�L A✓ :L L s -k- �-1— "� 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 to entupon the a ove- mentioned property for inspection purposes. Q n Y „ Da C>� Signature (Applicant or Ag ummma MUM DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ' ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 101-0000-42403 0 $23.83 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE DEVICES, FIRST 20 PC 101-0000-42600 0 $23.83 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for ELECTRICAL: $47.66 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE REMODEL, EA ADDITIONAL 500 SF 101-0000-42400 0 $21.45 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE REMODEL, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $17.16 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE REMODEL, FIRST 100 SF 101-0000-42400 0 $48.62 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE REMODEL, FIRST 500 SF PC 101-0000-42600 0 $132.99 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forREMODEL: $220.22 $0.00 .rr .,,. v y � OF Permit Detail's� City Of La Quinta PERMIT IV.U.MBER RERy14-837 Description: KITCHEN REMODEL ONLY Type: BUILDING, RESIDENTIAL Subtype: REMODEL Status: APPROVED Applied: 6/12/2014 Approved: 7/17/2014 AOR Parcel No: 658270050 Site Address: 77935 LAGO DR LA QUINTA,CA 92253 Subdivision: TR 4418 & INT COMMON AREA Block: Lot: 25 Issued: Lot Sq Ft: Building Sq Ft: Zoning: Finaled: Valuation: $21,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: No. Stories: No. Unites: Details: REMODEL TO KITCHEN -REPLACEMENT OF CABINETS, FIXTURES, APPLIANCES AND RELOCATION OF ELECTRICAL TO ACCOMMODATE REVISED LAYOUT. THIS PERMIT DOES NOT INCLUDE ADDITIONAL CONDITIONED SQUARE FOOTAGE OR ALTERATION TO BUILDING FRAMING. 2013 CALIFORNIA BUILDING CODES. 35 es=wmma i Applied to Approved '..'4.ts N. ANCIAL...Is.NQ..-F. vOR.e:M=:avAe^TIr.O-,camN A`4L�� Bw�� Printed: Wednesday, August 13, 2014 7:53:47 AM 1 of 2 C(J[.( MYSTEMS mom 0 0 . NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT RUBARTH CONSTRUCTION 54275 AVENIDA VELASCO LA QUINTA CA 92253 CONTRACTOR RUBARTH CONSTRUCTION 54275 AVENIDA VELASCO LA QUINTA CA 92253 OWNER THOMAS CURTIS 3300 TOMAHAWK RD MISSION HILLS KS 92253 '..'4.ts N. ANCIAL...Is.NQ..-F. vOR.e:M=:avAe^TIr.O-,camN A`4L�� Bw�� Printed: Wednesday, August 13, 2014 7:53:47 AM 1 of 2 C(J[.( MYSTEMS Permit Details City of La Quinta PERMIT NUMBER RE9,- 37 - - CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: DEVICES, FIRST 20 101-0000-42403 0 $23.83 $0.00 DEVICES, FIRST 20 PC 101-0000-42600 0 $23.83 $0.00 Total Paid for ELECTRICAL: $47.66 $0.00 REMODEL, EA 101-0000-42400 0 $21.45 $0.00 ADDITIONAL 500 SF REMODEL, EA 101-0000-42600 0 $17.16 $0.00 ADDITIONAL 500 SF PC REMODEL, FIRST 100 SF 101-0000-42400 0 $48.62 $0.00 REMODEL, FIRST 500 SF 101-0000-42600 0 $132.99 $0.00 PC Total Paid for REMODEL: $220.22 $0.00 .._.. ->. INSPECTIONS W9,77PARENT PROJECTS BOND INFORMATION ATTACHMENTS Printed: Wednesday, August 13, 2014 7:53:47 AM 2 of 2 Clan srsrEms Description: KITCHEN REMODEL ONLY Type: BUILDING, RESIDENTIAL Subtype: REMODEL Status: APPROVED Applied: 6/12/2014 Approved: 7/17/2014 AOR Parcel No: 658270050 Site Address: 77935 LAGO DR LA QUINTA,CA 92253 Subdivision: TR 4418 & INT COMMON AREA Block: Lot: 25 Issued: �OlE Lot Sq Ft: Building Sq Ft: Zoning: Finaled: Valuation: $21,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: No. Stories: No. Unites: Details: REMODEL TO KITCHEN -REPLACEMENT OF CABINETS, FIXTURES, APPLIANCES AND RELOCATION OF ELECTRICAL TO ACCOMMODATE REVISED LAYOUT. THIS PERMIT DOES NOT INCLUDE ADDITIONAL CONDITIONED SQUARE FOOTAGE OR ALTERATION TO BUILDING FRAMING. 2013 CALIFORNIA BUILDING CODES. NAME�TYPE + K $ : t.SNAMEr�+ c..:�DRES51� E. TY� ZIP _ -PHONE �,,AX - - 'EM�AaIL APPLICANT RUBARTH CONSTRUCTION 54275 AVENIDA LA QUINTA CA 92253 VELASCO CONTRACTOR RUBARTH CONSTRUCTION 542DA LA QUINTA CA 92253 VELAS O ��` 5,�� Sc OfpA'!v QiQo OWNER THOMAS CURTIS 3300 TOMAHAWK RD MISSION HILLS KS 92253 Printed: Thursday, July 17, 2014 4:15:10 PM 1 of 2 SYSTEMS DESCRIPTION 01 ACCOUNT AMOUNT PAID PAID DATE RECEIPT # CHECK•# METHOD PAID BY CLTD - 9L BY BSAS SB1473 FEE 101-0000-20306 --- $1.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00 - BSA: DEVICES, FIRST 20 101-0000-42403 0 $23.83 $0.00 DEVICES, FIRST 20 PC 101-0000-42600 0 $23.83 $0.00 Total Paid forELECTRICAL: $47.66 $0.00 REMODEL,EA 101-0000-42400 0 $21.45 $0.00 ADDITIONAL 5000 SF REMODEL, EA 101-0000-42600 0 $17.16 $0.00 ADDITIONAL 500 SF PC REMODEL, FIRST 100 SF 101-0000-42400 0 $48.62 $0.00 REMODEL, FIRST 500 SF 101-0000-42600 0 $132.99 $0.00 PC Total Paid for REMODEL: $220.22 $0.00 TOTALS: $268.88 00 INSPECTIONS BOND INFORMATION Printed: Thursday, July 17, 2014 4:15:10 PM 2 of 2 srsTrMs Bin # Qty -of La Quinta -Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico . La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address:' 7 Owner's N A. P. Number: Address: 7,7f 75,,�. Legal Description: City, ST, Zip: / -4 e.4 Contracto J.WG 4_o '� n(. '�i` u Telephone: Address: — 2 15 Avc t1ctA4ec-.) Project Description: �£ . City, ST, Zip: J 1 ` .� (�.4,45. ee✓ d,0,6 Telephone: :v s:.i:;.;,:;: <:z: ;:>;•>;:;:><:,;>:. ,p I ' State Lic. # : 5 CityLie. #t 16, z 94o -1 Arch., Engr., Designer. Address: City., ST, Zip: Telephone: >:::>.::> '`<'< N'w%><» :::>>:;.r:;.•z•:<:»»:;».<is ::::>:><::»:: Construction Type:" Occupancy: State Lic. #: Project a circle one): New d' Alter J tYP ) A r Repair Demo Name of Contact Person: Sq. Ft.: e7 # Stories: # Units: / Telephone #,of Contact Person: 6o -6ol m Estimated Value of Project: QQO . o APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES. Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Cales. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2n' Review, ready for correctio issue lectrical Subcontactor List Called Contact Person lumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- '`° Reyiew, ready for corrections/issue Developer Impact Fee Planning Approval Called. Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Le S - �g-A-t ' School Name Teacher Name Class/Project l � ate k�� JJ� f>' 'r- 2J . - a QM e V^ A p . 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