13-1343 (RR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA.QUINTA, CALIFORNIA 92253
Application. Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
13-00001343
78002 LAGO DR
658-270-034-9 -4418 -
REMODEL - RESIDENTIAL
LOW DENSITY RESIDENTIAL
3500
T`�
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BUILDING & SAFETY DEPARTMENT.,,
BUILDING PERMIT
Owner:
RICHARD BOZEK
78002 LAGO DRIVE
LA QUINTA, CA 92253
(
Architect or Engineer:
-----------------
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: License No.:
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 ISec. 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
apy $pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($5001.:
I fHV(�t'%n 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 sate.).
( o.l, 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 th n, and contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' Stat is nsa w.l.
( Iam exempt under Sec. .&P C. o [his re
a ii
Date: I G-' I ' a0 J 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: �(�\
V -
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011 .
INSPECTIONS (760) 777-7153
Contractor. D �
Owner
OCT 013 J
L•l�
------------------
WORKER'S COMPENSATION DECLARATION
Date: 10/21/13
1 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 - - - - - - - - - - - - - - - - -- - - - -- Policy Number
F I certify that, in the perf r ance of he w k for which this permit is issued, I shall not employ any
person in any mannr o to om s bject to the workers' compensation laws of California,
and agree that, if 1 h ul b c e su je t to the workers' compensation provisions of Section
'�t1 13700 of the Labo d , I rt comply with those provisions.
Date:/0'oI -�b'1 Applicant:
C
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 1$100,0001. 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 bui in co trio nd h reby authorize representatives
of this county to enter upon the above-mentioned pro y or ' spe ti urpos s.
Dater ignature (Applicant or Agent):
Application Number . . . . 13-00001343
Permit REMODEL 2013
Additional desc .
Permit Fee . . . . 155.87 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 4/19/14
Qty Unit Charge Per
Extension
1.00 48.6200 LS MISC REMODEL, 1ST 100 SF
48.62
5.00 21.4500 EA MISC REMODEL, ADDL 500 SF
----------------------------------------------------------------------------
107.25
Permit . . . ELECTRICAL 2013
Additional desc .
Permit Fee 23.83 Plan Check Fee
.00
Issue Date . . . . Valuation
0
Expiration Date 4/19/14
Qty Unit Charge Per
Extension
1.00 23.8300 LS ELEC FIXTURES, FIRST 20
23.83
-----------------------------------------7----------------------------------
Special Notes.and Comments
REMODEL - REPAIR RAIN AND TERMITE
DAMAGE, DRYWALL IN KITCHEN, WALL BY
FIREPLACE, AND TV ROOM. PERMIT INCLUDED
ELECTRICAL_ IN KITCHEN FOR REPLACEMENT
ONLY LIKE FOR LIKE. REPLACE ONE POST OF
PATIO COVER. 2010 CALIFORNIA BUILDING
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . PLAN CHECK, ELECTRICAL
23.83
PLAN CHECK, REMODEL
218.79
PERMIT ISSUANCE M/P/E
90.57
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 179.70 .00 .00
179.70
Plan Check Total .00 .00 .00
.00
Other Fee Total 333.19 .00 .00
333.19
Grand Total 512.89 .00 .00
512.89
11
LQPERMIT
Din #
City of La Quints
Building gr Safety 'DWon
P.O. Box 1504, 78495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: Zkc;�-ZAqo
Owner's Name: Ric R-4 113OZC4,
A. P. Number
Address: 2,foo� 44qqc�auvc
Legal Description:
Contractor:011J A) e1L
City, ST, Zip:
telephoal/
—A)IA
Address:
Project Description —777—
City, ST, Zip:wG;)L
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Telephone:
0,0,0, iL DAJ, deQ 411J V 64ckd
State Lic. #
City Lic.
JV
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'J c 6 0- -bil V o- 167,A 11 7e
Arch-, Engr.. Designer
uqe,04J,zj pe-1`4 rill,
Address:
vl
e
-(4/L,,-, I 110 tl3ipbscGJt
City, ST, Zip:
Ale cfl/L'pe�
OEMTelephone:-
State Lic. #: NOMINEE -
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Construction type: 6ccupan,cy:
Project type (circle one): New Add'n Alt Repair Demo
Name of Contact Pers 6
Sq. FL:
# Stories:
# Units:
Telephone #,of Contact PeQ/ q e,�dzzz
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recld
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural CuIcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calks.
Plans pickii! up
Construction
Flood plain plan
Plans resubriii tted
Mechanical
Grading plan
21' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE--
Review, ready for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
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Total Permit Fees
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CITY OF LA QUINT"A
BUILDING & SAFETY DEPT.
APPROVED
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CITY OF LA QUINT"A
BUILDING & SAFETY DEPT.
APPROVED
DATE (a23