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BRES2016-02144 78-495 CALLE TAMPICO Ct 0 D Q" LA QUINTA, CALIFORNIA 92253 -DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRES2016-0214 Property Address: 53825 AVENIDA RAMIREZ APN: 774161018 Application Description: SIPOVAC/1,694SF DWELLING/VB/RES-3/CLASS A-FR/13D Property Zoning: Application Valuation: $106,265.60 Applicant: SIPOVAC CONSTRUCTION INC 72651 THEODORA LANE PALM DESERT, CA 92260 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. C33, C53, C-9, C10, C20, C36, C21 License No.: 581636 Date:%Z G Contra ��ftk_� 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).: (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.). (_) 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 Lender's Address: (760)567-2347 Llc. No.: 581636 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 ave and will maintain workers' compensation insurance, as required by ection 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 COMPENSATION INSURANCE FUND Policy Number: 9087965 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. .1� Date Applicannt'l 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 enter upon the above-mentioned property for inspection purposes. gate: Signature (Applicant or Agent): VOICE (760) 777-7125 CM 11 INNECTIONS 6�- 53 n Date: 12/5/2016 CZ) !P r►l Owner: ANDREW SIPOVAC rD ry m a c' 0 a Contractor: SIPOVAC CONSTRUON I 72651 THEODORA LANE PALM DESERT, CA 92260 (760)567-2347 Llc. No.: 581636 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 ave and will maintain workers' compensation insurance, as required by ection 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 COMPENSATION INSURANCE FUND Policy Number: 9087965 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. .1� Date Applicannt'l 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 enter upon the above-mentioned property for inspection purposes. gate: Signature (Applicant or Agent): Date: 12/5/2016 Application Number: BRES2016-0214 Owner: Property Address: 53825 AVENIDA RAMIREZ ANDREW SIPOVAC APN: 774161018. Property Zoning: Application Valuation: $106,265.60 l Applicant: Contractor: SIPOVAC CONSTRUCTION INC SIPOVAC CONSTRUCTION INC 72651 THEODORA LANE 72651 THEODORA LANE PALM DESERT, CA 92260 PALM DESERT, CA 92260 (760)567-2347 Llc. No.: 581636 --------------------------------------------------------------------------------------------- Detail: SIPOVAC / 1,694 SF DWELLING - [VB/RES-3/CLASS A-FR/13D] CONVENTIONAL LIGHT FRAME CONSTRUCTION. THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 2013 CALIFORNIA BUILDING CODES. FINANCIAL •• l. DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE.- CITY BUILDING STAFF 101-0000-42600 2.5 $380.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - CITY BUILDING STAFF 101-0000-42600 1.5 $228.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - CITY BUILDING STAFF 101-0000-42600 1 $152.00 Total Paid for BLDG CITY STAFF - PER HOUR: $760.00 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $5.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $5.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - CIVIC CENTER 252-0000-43200 0 $942.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - LIBRARIES 253-0000-43200 0 $344.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - PARKS/REC 251-0000-43200 0 $2,048.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $24.66 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $10.16 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $145.03 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47.86 Total Paid for ELECTRICAL - NEW CONSTRUCTION: $227.71 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT <=7KSF 101-0000-42408 0 $36.26 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT <=7KSF PC 101-0000-42600 0 $36.26 Total Paid for GRADING: $72.52 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $72.52 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $48.34 DESCRIPTION ACCOUNT QTY AMOUNT EXHAUST HOOD 101-0000-42402 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT EXHAUST HOOD PC 101-0000-42600 0 $4.83 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE 101-0000-42402 0 $72.52 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE PC 101-0000-42600 0 $48.34 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $36.27 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $14.49 Total Paid for MECHANICAL: $309.40 DESCRIPTION ACCOUNT QTY AMOUNT MULTI -SPECIES RESIDENTIAL 8.1-14 UNITS - 2016 UPDATE 101-0000-20310 0 $508.00 Total Paid for MULTI -SPECIES RESIDENTIAL: $508.00 DESCRIPTION ACCOUNT QTY AMOUNT .NEW CONSTRUCTION PERMIT 101-0000-42400 0 $505.23 Total Paid for NEW CONSTRUCTION PERMIT: $505.23 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $981.99 Total Paid for NEW CONSTRUCTION PLAN CHECK: $981.99 DESCRIPTION ACCOUNT QTY AMOUNT BACKFLOW DEVICE 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT BACKFLOW DEVICE PC 101-0000-42600 0 $4.83 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER PC 101-0000-42600 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $120.90 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $120.90 DESCRIPTION ACCOUNT QTY I AMOUNT GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 1-4 OUTLETS PC .101-0000-42600 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT ROOF DRAIN 101-0000-42401 0 $72.54 DESCRIPTION . ACCOUNT QTY AMOUNT ROOF DRAIN PC 101-0000-42600 0. $72.54 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT ` WATER HEATER/VENT PC 101-0000-42600 0 $7.25 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 Total Paid for PLUMBING FEES: $507.76 DESCRIPTION ACCOUNT QTY AMOUNT 'SMI - RESIDENTIAL 101-0000-20308 0 $13.81 • Total Paid for STRONG MOTION INSTRUMENTATION SMI: $13.81 DESCRIPTION ACCOUNT Y AMOUNT SINGLE FAMILY DETACHED 224-0000-20320 - Ll $1,837.44 Total Paid for TUMF - RESIDENTIAL: $1,837.44 P.O. BOX 1504 APPLICATION ONLY Building713-495 CALLE TAMPICO Address PUe, i� I v1?z LA QUINTA, CALIFORNIA 92253 Owner S106GI VI OVA,C. Address 72651-Tlnec�ovlti Zln. City Zip Tel. �,, ,� vsetr+ 260 760-56_7--Z3g7 SlPo�/4u (',ontsivvckf)IA , kke, Address ' 72651 `rlto8 ovc, Lv, , City Zip Tel. pawl V�)eseV4- 9 ZZ6-0 760 -6-67-23`1-7 & Classif. 51E� 16 3 (0 I Lic. # Arch., Engr., Designer S I Vl,C trc7vlS�f/UL I C9'1� 1 ry G Address Tel. ,L 72661 _11e00v(- '760-56 7 City Zip State �es�v�' 'Zz6rJ Lic. # 51 6.36 LICENSED CONTRACTOR'S DECLARATION I hereby affirm 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. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contrac- tor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he 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). 111, 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 Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such 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 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 Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractors) licensed pursuant to the Contractor's License Law) 0 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKER'S COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less). 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 Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 enter the above-mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT BUILDING: TYPE CONST. v _'�) OCC. GRP. A.P. Number i79 -1 h - 0 IC2 Legal Description 9rr 6 5LJ< , 236 TRS. Z36 L19/ 6 /�f 235 4A 15 020/ Project Description aT Ale4.) r97vnUM/'_ - Vf� LC1z-5%VUdi0LA. Sq. Ft. j No. No. Dw. r Size Stories Z Units Newp< Add ❑ Alter ❑ Repair ❑ Demolition ❑ (� V eAA ' &U J -Ft-aA4- I'I tr I AID sdvudwtd Ccjc.S —J.,,, Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. ^220 DU a) Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL AZO OC70 CONTACT INFORMATION NAME: &a� SIROLAL PHONE: 7(,0 -.667 - Z31-17 ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from dear Prop. Line Side Street Setbacl• from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Validated by: — Validation: YELLOW = APPLICANT Date PINK = FINANCE Building Permit Numbsi: Project Description: SFR Exempt (Materials may contain hazardous wastes and are not subject to recycling provisions) Construction Debris Management Plan Plan Submittal Datel 09/15/16 Job Site Owner's Name Number, Street, or PO Box City, State, Postel Code Owner's Phone Number Owner's E -Mail Address Project Managers Name Project Managers Phone Number Project Managers E -mall Address Builder / Contractor Number, Street or PO Box City, State, Postal Code Project Square 53625 Avenida Ramirez Andrew Sipovac 43619 Buena Cir Palm Desert, CA 92260 andrewfteioovac.com Bob Slpovac 760-567-2347 bobdbataovaacom Slpovac Construction, Inc. 72651 Theodora Ln. Palm Desert, CA 92260 1694 square feet '�& a1aA-hF-e'/'h4WtW-Vh� City Approval By Date of City Approval 09 ► $ �(� To Be Discarded: Product Trash Asphalt Brick/Block Cardboard Commingled Concrete Drywail Donated / Reuse* "Describe Items Tons able Product Masonry (broken) Plaster Scrap Metal Tile (floor) Tile (roof) Wood Landscape Debris Tons 0.00 1.75 Recycle Trash Projected Diversion: 11.9 7.5 61.28°�6 i understand It is the property owner's responsibDlty to submit copies of weight tickets or receipts to the District Environmental Coordinator as these hauls occur. I hereby certify that completion, implementation and adherence of the i Debris Management Plan (DMP) for the above named project shall guarantee that at least 50% of the jobsite waste is ;diverted from landfilling. The remaining material will be recycled or reused. I will divert, for recycling or re -use, remaining imaterials generated from the first day of the project through the completion of the project in accordance with this plan. This IDMP Is issued in the name of the property ownar(s) and shall remain their property throughout the construction and/or 'demolition project. A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP is still I Issued in the name of the property owner(s) and the owner retains legal responsiblltty for ensuring that the provisions of the DMP are adhered to. The property owner(s) and general contractor shall be kept informed of the diversion progress through bi•-rnonthiy reports. If self -hauling, all refuse material from this project site must be taken to an approved recycler or transfer 24:ZS - 17i I Owner / OvAloperLTiRroject Manager / Superintendent 1 Date