BPAT2016-011078-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPAT2016-0110
Property Address: 44125 CAMINO LAVANDA
APN: 604180052
Application Description: VILLANUEVA RESIDENCE/ PATI
Property Zoning:
Application Valuation: $3,000.00
Applicant:
ANILOM INC DBA GOLD STAR CUSTOM PAINTING
77-682 COUNTRY CLUB DR STE H
SUITE F363
PALM DESERT, CA 92211
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/9/2016
Owner:
V► ® PAUL CAMN
44125 CAMINO LA LAVANDA
LA QUINTA, CA 92253
DEC 0 9 2016
CITY OF Contractor:
QUINTA ANILOM INC DBA GOLD STAR CUSTOM PAINTING
DESIGN AND DEVELOPMENT DEPARTMENT 77-682 COUNTRY CLUB DR STE H
SUITE F363
PALM DESERT, CA 92211
(760)641-7544.
Llc. No.: 855623
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 th�Businesssions Code,
and my License is in full force and effect.
License Class: C33, C51 License No.: 85562
Date: l Contract
OWNER -BUILDER CLARATION
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 fora
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_ 11, 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 ) 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 Name: f
Lender's Address:
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 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: ACE AMERICAN INSURANCE COMPANY Policy Number: RWCC48814682
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 becomes Je to the workers'
compensation laws of California, and agree that, if I shouldbecorhe subject to the
workers' compensation provisions of Section 3700 oft Labor Code, I shall forthwith
comply with those provisions.
Date:4 y Applicant:
WARNING: FAILURE TO SECURE WORKERS' OMPENSATION 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 r in o building
construction, and hereby authorize representatives of thi City to ter a on the
above-mentioned property for inspection purposes.
Date: l�`' -( /� Signature (Applicant or t
z
Date: 12/9/2016
Application Number: BPAT2016-0110
Owner:
Property Address: 44125 CAMINO LAVANDA
PAUL VILLANUEVA
APN: 604180052
44125 CAMINO LAVANDA
Application Description: VILLANUEVA RESIDENCE / PATIO COVER
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $3,000.00
Applicant:
Contractor:
ANILOM INC DBA GOLD STAR CUSTOM PAINTING
ANILOM INC DBA GOLD STAR CUSTOM PAINTING
77-682 COUNTRY CLUB DR STE H
77-682 COUNTRY CLUB DR STE H
SUITE F363
SUITE F363
PALM DESERT, CA 92211
PALM DESERT, CA 92211
(760)641-7544
---------------------------------------------------------------------------------------------
LIC. No.: 855623
Detail: FREESTANDING ALUMAWOOD PATIO 300 SF IN REAR OF PROPERTY INSTALL FAN AND ELECTRICAL. PER 2013 CALIFORNIA BUILDING CODE.
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DESCRIPTION
ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION.
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, STD, OPEN
101-0000-42404
0
$101.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, STD, OPEN PC
101-0000-42600
0
$100.32
Total Paid for PATIO COVER / COVERED PORCH / LATTICE: $202.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$0.50 '
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50
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PAUL
VILLANUAVA
44125 CAMINO
LAVA N DA
LA QUINTA, CA
DRIVEWAY
STREET
Qin r`i '
City of La Qullita
Building 8t Safety Division
Permit # 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: ' ti( rc R
G l
Telephone:
Address:
ItlV
Project Description:
City, ST, Zip:
Telephone:
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................,...............
State Lic. # : lO��
City Lic.
Arch., Engr., Designer:
Address:
V.
City, ST, Zip:
h
Telephone:
one:
............. A
Construction n TYPe• Occupancy:
cY:
,
State Lic. #.
New Add n
ProJect hPecircle one • Alter Repair Demo
0
Name of Contact Person:
Sq.Ft:
#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
It
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subcontacl'orList
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
I-I.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"! Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
I
Total Permit Fees