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12-1128 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: r�:nrrsrss 12-00001128 52334 AVENIDA RUBIO 773-253-024-20 -000000- REMODEL - RESIDENTIAL COVE RESIDENTIAL 200,00 T`t4 t44Q," Architect or Engineer: PIa BUILDING &, SAFETY DEPARTMENT BUILDING" PERMIT Owner: ALEXSA GOBEL 52334 AVENIDA RUBIO LA QUINTA, CA 92253 .Contractor. CASTLE CONSTRUCTION 68670 LOS GATOS CATHEDRAL -CITY, CA 92 (760.)272-4191 Lic. No.: 675800 1*0_� VOICE (760) 777-7012 FAX (760) 777-7011 +SPECTIONS (760) 777-7153 Date: 11/08/12 Nov oa poll D ------7-------------------------------------=---------------------------------------------------- LICENSED CONTRACTOR'S (DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions o{Chapter 9_(cammencin6 with. I hereby affirm under penalty of perjury one of the.following declarations' Section 7000) of Division 3 of the Business and Professionals Code, and my License is in'tull torce;and effect. Lice Class: B - License No.: 675800 _� 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 Date: jd nttactor:.'. _ ,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 peimit is issued. My workers' compensation OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am.exempt'from,the Contractor's State License'Law.for the insurance carrier and policy number are: Carrier STATE FUND:` .Policy Number 1863381-2012 following reason (Sec. 7031.5, Business and Pedfessions Code': Any city_or county that requires a permit tq. _ I certify tfiat, in the performance ofthe work for which this permit is issued, I shall not employ any construct, alter, improve; demolish, or repair. any structure prior to its issuance, also requires the applicant for the person in any manner so as to'become subjecilto.the workers' compensation laws of California, permit to file'a signed statement that he or sheds licensed pursuanf to the provisions of the.Contractor.'s.State and agree that, if I should become subject to the.woikers' compensation provisions of Section License Law (Chapter 9 (commencing with'Secfion 7000) of Division 3 of the,8usiness and Professions Code). or 3700 of the LaborCode, I shallforthwith comply with those provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violationof Seation'7031.5 by - y any applicant for a permit subjects the applicant to a civilpenaltyof not more than five hundred dollars ($500).:ate: plicant: - (_ I 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 . WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through -his or her own employees, provided that the DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold,within SECTION 3706 OF THE LABOR CODE,.INTEREST, AND ATTORNEY'S FEES. 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.). APPLICANTACKNOWLEDGEMENT (_ 1 l; as owner of the property, am exclusively contracting with licensed contractors to construct the project (Seca IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License. Law does not apply to;an owner of conditions and restrictions set forth on this application. Property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is'made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as'a result .of this application, (_ 1 I am exempt under Sec. , B.&P.C. for this reason 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. Date: Owner: 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 CONSTRUCTION LENDING AGENCY permit to cancellation. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.I. city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter u n the above-mentioned property for inspection purposes. Lender's Name: _ ate: gnature (Applicant or Agent): Lender's Address: LQPERMIT LQPERMIT 0 Application Number . . . . . 12-00001128 Structure Information INTERIOR REMODEL THROUGHOUT DWELLING ----- ---------------------------------------------------------------------------- Other struct info . . . . . CODE EDITION 2010 Permit . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee . . . . 26.00 Plan Check Fee 6.50 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 5/07/13 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- 1.00 11.0000 EA ELEC MISC 11.00 Permit . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 207.00 Plan Check Fee 134.55 Issue Date . . . . Valuation . . . . 20000 Expiration Date . . 5/07/13 Qty Unit Charge Per Extension BASE FEE 45.00 ---------------------------------------------------------------------------- 18.00 9.0000 THOU BLDG 2,001-25,000 162.00 Permit . . . MECHANICAL Additional desc . . Permit Fee . . . . 28.00 Plan Check Fee 7.00 Issue Date . . . . Valuation .. . . . 0 Expiration Date . 5/07/13 Qty Unit Charge Per Extension. BASE FEE 15.00 1.00 6.5000 EA MECH VENT FAN 6.50 --------------------------------------------=------------------------------- 1.00 6.5000 EA MECH EXHAUST HOOD 6.50 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 39.00 Plan Check Fee 9.75 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/07/13 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 6.0000 EA PLB FIXTURE 18.00 LQPERMIT 0 LQPERMIT Application Number . . . . . 12-00001128 Permit . . . . . . PLUMBING Qty Unit Charge Per Extension 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments REMODEL TO INTERIOR OF DWELLING ONLY (ENGINEERED] REVISE KITCHEN LAYOUT INCLUDING LIGHTING, ADD POWDER ROOM AT EXISTING WETBAR AREA, REVISE CLOSETS AT BEDROOMS, INSTALL_EMERGENCY ESCAPE AND RESCUE OPENING AT FRONT BEDROOM AND INSTALL TWO (2) SOLATUBS. THIS PERMIT DOES NOT INCLUDE ADDITIONAL CONDITIONED SQUARE FOOTAGE OR REPLACEMENT OF HVAC EQUIPMENT, WATER HEATER OR FENESTRATION SURFACES. 2010 CALIFORNIA BUILDING CODES. November 6, 2012 4:59:28 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 13.46 STRONG MOTION (SMI) - RES 2.00 Fee summary Charged Permit Fee Total 300.00 Plan Check Total 1-57.80 Other Fee Total 15.46 Grand Total 473.26 Paid Credited Due .00 .00 300.00 .00 .00 157.80 .00 .00 15.46 .00 .00 473.26