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LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BRES2016-0215
Property Address:
51081 AVENIDA RAMIREZ
APN:
773061015
Application Description:
GARCIA/ 2,548 SF DWELLING/VB/RES-3/CLASS A-FR/13D
Property Zoning:
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Application Valuation:
$164,129.80
Applicant:
MICAH COMBS
75-145 ST. CHARLES PLACE #4
PALM DESERT, CA 92211
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: B License No.: 818121
6-a Contractor: kopr f`-�
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.).
(_) 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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
GARCIA ARMANDO & STELLA
80876 DARTMOUTH AVE
INDIO, CA 92201
Contractor:
K P HUDSON CONSTRUCTIO
40905 AMADOR DR
INDIO, CA 92203
(760)275-6137
Llc. No.: 818121
Date: 10/26/2016
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.
&Lf 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:
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.
Date: to uO �� Applicantg,.W CcJ �S
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
abovee--mentioned property for inspection purposes.
Dat l a`s—� Signature (Applicant or Agent).
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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.
&Lf 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:
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.
Date: to uO �� Applicantg,.W CcJ �S
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
abovee--mentioned property for inspection purposes.
Dat l a`s—� Signature (Applicant or Agent).
Application Number:
BRES2016-0215
Property Address:
51081 AVENIDA RAMIREZ
APN:
773061015
Application Description:
GARCIA/ 2,548 SF DWELLING/VB/RES-3/CLASS A-FR/13D
Property Zoning:
Application Valuation:
$164,129.80
Applicant:
MICAH COMBS
75-145 ST. CHARLES PLACE
#4
PALM DESERT, CA 92211
Date: 10/26/2016
Owner:
GARCIA ARMANDO & STELLA
80876 DARTMOUTH AVE
INDIO, CA 92201
Contractor:
K P HUDSON CONSTRUCTION INC
40905 AMADOR DR
INDIO, CA 92203
(760)275-6137
Llc. No.: 818121
Detail: GARCIA / 2,548SF SINGLE FAMILY DWELLING - [VB/RES-3/CLASS A-FR/13D] (2,028 SF MAIN HOUSE W/ 520 SF ATTACHED CASITA) THIS PERMIT DOES
NOT INCLUDE POOL, SPA, BLOCK WALLS OR DRIVEWAY APPROACH. 2013 CALIFORNIA BUILDING CODES.
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $7.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $7.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TEMP POWER SERVICE
101-0000-42403
0
$24.17
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TEMP POWER SERVICE PC
101-0000-42600
0
$16.92
Total Paid for ELECTRICAL: $41.09
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RESIDENTIAL, EA ADDITION 1,000SF
101-0000-42403
0
$36.99
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RESIDENTIAL, EA ADDITION 1,000SF, PC
101-0000-42600
0
$15.24
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$145.03
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$47.86
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $245.12
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT >7KSF
101-0000-42408
0
$36.26
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT >7KSF PC
101-0000-42600
0
$181.29
Total Paid for GRADING: $217.55
DESCRIPTION
ACCOUNT
CITY
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402
0
$72.52
DESCRIPTION
. . ACCOUNT
CITY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$48.34
DESCRIPTION
ACCOUNT
CITY
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
$60.45
DESCRIPTION
ACCOUNT
QTY
AMOUNT
VENT FAN PC
101-0000-42600
0
$24.15
Total Paid for MECHANICAL: $343.24
DESCRIPTION
ACCOUNT
QTY
AMOUNT
NEW CONSTRUCTION PERMIT
101-0000-424000
$552.79 .
Total Paid for; NEW CONSTRUCTION -PERMIT: $552.79
DESCRIPTION s
ACCOUNT
QTY
AMOUNT
NEW CONSTRUCTION PLAN CHECK
101-0000-42600.
0
$1,129.94
Total Paid.for NEW CONSTRUCTION PLAN CHECK: $1,129.94
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
$169.26
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC
101--000042600 -
0
$169.26
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
10170000-42401
0
$12.09
DESCRIPTION
ACCOUNT.
QTY
AMOUNT
GAS SYSTEM, 174,OUTLETS PC
'101-0000-42600.
0'
$24.17
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 Paidfor.PLUMBING FEES: $442.48
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL:
101-0000-20308.
0
$21.34
•Total.Paid foc STRONG MOTION�INSTRUMENTATION SMI: $21.34
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TUT44a"
P.O. BOX 1504
Building / / Q y n p� 78-495 CALLE TAMPICO
Address ` �/ V I F""TuT�i % 1 (�-9PUINTA, CALIFORNIA 92253
Address
WI V RMEM,
ME
Cor P for 1� . lv 0 L 1 �%�r' Ill J I'-) I
City
State Lie. City
& Classif. 00 i % (Z I Lie. #
Arch., Engr.,
Designer
Address Tel.
Lie. #
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).
❑ 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 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 contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & PC. for this reason
Date Owner
WORKER'S COMPENSATION DECLARATION
I 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 if the permit is for one hundred dollars ($100) valuation
or less).
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
APPLICATION ONLY
BUILDING: TYPE CONIST. P. OCC. GR
A.P. Number ;ii-l 3 I - O l�—
Legal Description ��"",,��ii
Project Description _�L
Sq. Ft. No. No. Dw.
Size Stories Units
NeW16_ Add ❑ Alter ❑ Repair ❑ Demolition ❑
�Ain 0 - 2Ig
Estimated Valuation ODr CIO
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
CONTACT INFORMATION
NAME:
PHONE:
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = BUILDING DEPARTMENT YELLOW = APPLICANT PINK = FINANCE
Bin ##
City of La Q Uin to
Building lT Safety Division
_ 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #f
Project Address: S�-05�
Owner's Name: A�Qj)c,, C,�(zelA
A. P. Number:
Address:
Legal Description:
City, ST; Zip: 1l,4o ZZOt
Contractor:
N
Z (Q
Telephone: (x� ZS�oi
:. ;>xz�r:•w•.ra;.:.:<.:;:�.:..::
Address: LA09 C) S
Project Description:
city, ST, Zip: ( N p I C Q_,A ZZv3
Telephone:
Ph o . O-S -3
State Lic. # : tJ (
City Lie. #;
Arch., Engr., Designer: S U�
Address: _ U' ' S
City, ST, Zip: SPA 91L I 1
Telephone: e
P - L -(v
O�D 1
BEEN=
O ccu antY• Construction Type: pp
Y
State Lic. # •
Repair
Project CYP (circle ne) N Alterai r Demo
Name of Contact Person: wi I C-A (4
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 0- -7 q - 72-&
Estimated Value of Project:
APPLICANT; DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales. J
"940/
Called Contact Person
Plan Check Balance.
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`'. Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.1.P.P.
Pub. \Vks. Appr
Date of permit issue
School Fees,
Total Permit Fees
Date:10/18/2016
No.: 16-00376-1
Owner: Armando & Stella Garcia
Address:
City:
Type: Single Family Residential
Lot # Street No.
51081
Comments:
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Qunita, CA 92253
(760)771-8515
Email:
Jurisdiction: La Quinta
Tract #:
Street Name Sq. Feet APN
Avenida Ramirez 2548 773-061-015
0O%F1ED S
C
2 y00
11 BER4/UppAA DUNES
RANCHO MIRAGE
rd W1tMM OESERWELLS Y
� NACCKELLA p
a'4 LA m A y�i•
Permit No.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residen*i
under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking eating, or sanitation) or rep:,, -
mobile homes. It has been determined that the above -named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies that school facility fess imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $3.48 X 2548 S.F. or $8,867.04 have been paid for the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in the proposed project may now be issued.
Fees Paid By: CC/1st Bank - Stella Garcia Check No.: 1371789
Bank Name/Recipient of Certificate Telephone: 760-625-5665
Funding: Residential
By Dr. Gary Rutherford
Superintendent
Fee Collected/ Exempted by: Sharon
P
Amount Due: 8,86:%
Original Payrrent(s) Rec'd: $0 Cs
New Paymer.; Rec'd: $8,867.04
rover/Under: $0.''G
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify yol�tt%at the 90-day approval period in which you may protest
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the :i: _
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
Notice to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL.