13-0214 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T44f
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 13-00000214 ,
Property Address: 77955 CALLE COLIMA
APN: 774-135-001-24 -000000-
Application description: REMODEL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 900
Applicant: Architect or Engineer:
-7 ---------------
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: Bmo-:
926128
/Date: -2-:2W Contractor:
OW ER -BUILDER ECLARATION
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.).
1 _ I 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
1 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/28/13
Owner:
A & A HOMES
70600 COUNTRY CLUB
RANCHO MIRAGE, CA 92270
( a
Contractor. D r'✓� J 2d 1
DANTOR MARTINEZ CO' UCTZON
81057 A
INDIO,CAN92201DROME
C1�`( �CEpEP
(760) 702-6209 pINA
Lic. No.: 926128
-----------------------------------------------
WORKER'S COMPENSATION DECLARATION
1 hereby affirm under penalty of perjury one of the following declarations:
1>41 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.
17 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 STATE FUND INS Policy Number 1960997
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 1 should become subject to the workers' compensation provisions of Section
3700 of the Labor We, I shall for with cvrFpwith those provisions.
Date: ? r Applicant: I
WARNING: FAILURE TO SECURE WORKERS' COMPENSAPENSATION,
N COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF 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 building constr ction, and hereby authorize representatives
of this county to enter upon the above-mentioned pro a ty for inspec ion purposes.
Date: Signature (Applicant or Agent): _
Application Number . . . . . 13-00000214
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 23.00 Plan Check
Fee
14.95
Issue Date . . . . Valuation
. . .
. 900
Expiration Date . . 8/27/13
Qty Unit Charge Per
Extension
BASE FEE
15.00
4.00 2.0000 HND BLDG 501-2,000
8.00
------------- --------------------------------------------------------------
Special Notes and Comments
MINOR DEMO AND REFRAME DAMAGED GARAGE
(PER PLAN), LATH AND STUCCO, DRYWALL
1/2" TAPE. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
1.50
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 23.00 .00
.00
23.00
Plan Check Total 14.95 .00
.00
14.95
Other Fee Total 2.50 .00
.00
2.50
Grand Total 40.45 .00
.00
40.45
LQPEPM IT
Bin.#
Permit #
l/
Project Address:
City �f Lel Qi!(n>
Butting a Safety Duron
P.O. Box 1.504,78-495 Calle TamplCID
La.Quinta, CA 92253 - (760) 777-7012
Budding Permit Application and Tracking Sheet
S S Owner's Name:.
A. P. Number.
Adder:
Legal Description:City,
ST, Zip: r
Contractor. NTS r
Telephone: 6 S25 7 S—Q
Address:
Project Description:
City, ST, Zip: Z
O
C 92—
k-
Telephone: G
_ Q
State Lic. # :
City Lia M
.�
Archy Engr., Designer.
Address:
City, ST. Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Construction Type:. Ocwpaacy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: L f # Stories: # Unit;;:
Telephone I of Contact Person:
Estimatod Value of Project 'FQ'C}
APPLICANT: DO NOT WRITE BELOW THIS UNE
M
Submittal
Plan Sets
Req'd
Reed
TRACING PERMIT FEES
Plan Check submitted Itrst Amount
Structural Calcs.
Reviewed, ready for corrections Plan Check Deposit.
Truss Coles.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up `. Construction
Flood plain pian
Plans resubmitted Mechanical
Grading plan
2'' Review, ready for correctionstbaut Electrical
Subcontactor Ilst
Called Contact Person Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
''' Review; ready for correctlons/issae Developer Impact Fee
Planning Approval
Called Contact Person AJX.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
0
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�igSS
Com, I I e C n L '� ✓v�
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
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