BRES2015-0053tv-
�• VOICE (760) 777-7125
78-495 CHLLE TAMPICO
LA QUINTA; CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENTINSPECTIONS (760) 777-7153
BUILDING PERMIT
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 Cl s: B License No.: 750957 � (�' n c
Dater Contractor: [-J(I 1�T rn(Da j lea
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 1, 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, 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 I 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 Na
Lender's Address: `
(760)969-1400
Llc. No.: 750957
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one cf the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compe
psation, as provided for by Section 37CD of the Labor Code, for the performance of
thw k for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sec " 700 of the Labor Code, for the perfo -mance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier: _ 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 sc 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 37,of the Labor Code,'I shall forthwith
comply wi thosprovisions.
�� Applicant
Date: 01/03
WARNING: FAILURE TO SECURE WORKE S' COMPENSA ON COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000). N 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 tle Building Official for a permit subject to
the conditions and restrictions set forth on th s application.
1. Each person upon whose behalf this applcation 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, andhthe 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 1he work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appli:ation 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 stat aws relating to building -
construction, and hereby authorize representatives of this ci o enter upon the above -
mention edpNURS,griature
spection purposes.
Date: (Applicant or Age ):
Date:
2/20/2015
Application Number:
BRES2015-0053
Owner:
Property Address:
46243 ROUDEL LN
ROUDEL• VENTURES
APN:
600040023
27682 COUNTRY CLUB DRIVT�
Application Description:
ROUDEL TM 31816 LOT 26 PLAN 2
PALM DESERT, 92211
-
Property Zoning:
-•=A
r
a
Application Valuation:
$182,375.90
i�
N
c�9
a
Applicant:
Contractor:
-
ROUDEL VENTURES
G H A ENTERPRISES INC
Qm
W
27682 COUNTRY CLUB DRIVE STE. �
30=875 DATE PALM DRIVE STIC
Ll -
PALM DESERT, CA 92211
PALM
CATHEDRAL CITY, CA 92234-1747
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 Cl s: B License No.: 750957 � (�' n c
Dater Contractor: [-J(I 1�T rn(Da j lea
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 1, 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, 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 I 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 Na
Lender's Address: `
(760)969-1400
Llc. No.: 750957
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one cf the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compe
psation, as provided for by Section 37CD of the Labor Code, for the performance of
thw k for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Sec " 700 of the Labor Code, for the perfo -mance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrier: _ 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 sc 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 37,of the Labor Code,'I shall forthwith
comply wi thosprovisions.
�� Applicant
Date: 01/03
WARNING: FAILURE TO SECURE WORKE S' COMPENSA ON COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000). N 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 tle Building Official for a permit subject to
the conditions and restrictions set forth on th s application.
1. Each person upon whose behalf this applcation 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, andhthe 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 1he work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appli:ation 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 stat aws relating to building -
construction, and hereby authorize representatives of this ci o enter upon the above -
mention edpNURS,griature
spection purposes.
Date: (Applicant or Age ):
FINANCIAL INFORMATIONDESCRIPTIONS_
ACCOUNT'`'"
,AMOUNT'QTY�,'�
`,PAID PAIDDATE
BSAS SB1473 FEE 101-0000-20306 0
$8.00
$0.00
.PAID BY METHOD' RECEIPT#,
CHECK #' CLTD BY.'
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $8.00 $0.00
.'DESCRIPTION"'- '
; `` -.ACCOUNT � �;
QTY'.
AMOUNT
� PAID
PAID DATE
DIF - CIVIC CENTER
252-0000-43200
0
$942.00
$0.00
,PAID BY
METHOD
..,RECEIPT #. .
- •;CHECK#,'-',
CLTD BY,..
DESCRIPTION'
�'° ACCOUNT,
'QTYAMOWNT�'PAIDi
PAID DATE
DIF - COMMUNITY CENTERS
254-0000-43200
0
$129.00
$0.00
PAID BY _ a
METHOD .
`RECEIPT;#
" - CHECK #
CLTD BY.'
a DESCRIPTION
ACCOUNT "'
;QTY
AMOUNT'.
'PAID'
PAID DATE
DIF - FIRE PROTECTION
257-0000-43200
0
$433.00
- PAID BY
METHOD v,
='.RECEIPT#!y'. ` ''
CHECK#,; 'A `•
CLTD BY'
DESCRIPTION .$
ACCOUNT
QTY
;• AMOUNT,.
PAID
'PAID DATE
DIF - LIBRARIES
253-0000-43200
0
$344.00
$0.00
'PAID BY..
METHOD
'RECEIPT,# '�` -
-,,CHECK # ;
CLTD BY
.DESCRIPTION r
ACCOUNT"'
AMOUNT
PAID:-
PAID DATE
DIF - PARK MAINTENANCE
256-0000-43200
0
$40.00
$0.00
' :PAID BY :.
'METHOD: •,, R
'RECEIPT,# • a
CHECK #
CLTD BY
DESCRIPTION,
�'
QTY'.°AMOUNT.
• `PAID, .
PAID DATE
DIF - PARKS/REC
251-0000-43200
0
$2,048.00
$0.00
,. •� `, e�=. PAID BY "..'
h METHOD`, .' .. � .
^ .
-RECEIPT# �
'CHECK# . ,a�;
`
; CLTDBY,
DESCRIPTION
ACCOUNT • "� ,,
QTY `
`AMOUNT
:PAID ;;
:PAID'DATE
DIF - STREET MAINTENANCE
255-0000-43200
0
$116.00
$0.00
,a PAID BY
METHOD,' .
RECEIPT #;
,=ACHECK #
CLTD'BY
' DESCRIPTION,
,ACCOUNT.
QTY,
AMOUNT,
'PAID.
PAID DATE
DIF - TRANSPORTATION
250-0000-43200
0
$2,842.00
$0.00
."r PAID BY .m, 1% -
r METHOD
RECEIPT.#,
CHECK#.- ..
f CLTD'BY
Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $0.00
DESCRIPTION;`
ACCOUNT, -
QTY
AMOUNT -':
PAID. . '"
PAID DATE
TEMP POWER SERVICE
101-0000-42403
0
$24.17
$0.00
'° a;,.•,_ ° PAIDYBY „ k`
.METHOD
RECEIPT # .,;
CHECK #
CLTD BY.
Total Paid for ELECTRICAL: $24.17 _ $0.00
{, "DESCRIPTION-
ACCOUNT <
QTY''
' ., AMOUNT', '.
PAID
PAID DATE
RESIDENTIAL, EA ADDITION 1,000SF
101-0000-42403
0
$36.99
$0.00
PAID BY .
METHOD ._
RECHPT#, ::'
:` CHECK # ; ::
CLTD BY;
`.` DESCRIPTION' '
r t.. ". •< ACCOUNT
QTY:
AMOUNT.,
PAID._ ,' `.,
PAID GATE'
RESIDENTIAL, FIRST 1,000SF '
101-0000-42403
0
$145.03
$0.00
, PAID BY ` ,
.:
MMETHOD'
�� RECEIPT*
CHECK #'
"rCLTD BY; =
Total Paid forELECTRICAL - NEW CONSTRUCTION: $182.02 $0.00
DESCRIPTIONS
-' -ACCOUNT.
QTY."
AMOUNT,
PAID
PAID DATE
CONDENSER/COMPRESSOR
101-0000-42402 "
0
$36.26
$0.00.
. PAID BY,.- 7"<
'METHOD ' `,
RECEIPT # .'
r� .CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT . , x
PAID; .
PAID DATE
EXHAUST HOOD
101-0000-42402
0
$12.09
$0.00
a sPAID BY
.-METHOD:
RECEIPT #" €:
CHECK #
CLTD:BY<,.
DESCRIPTION,, �'
-< ACCOUNT
QTY
,AMOUNT. '< .
PAID `= r
PAID DATE'
FURNACE
101-0000-42402
0
$36.26
$0.00 •
g, PAID BY
METHOD. ` ¢
'.<RECEIPT #
� � CHECK # �
��CLTD BY.�
DESCRIPTION
- • ACCOUNT
QTY
AMOUNT
PAID ..;
PAID DATE
VENT FAN
101-0000-42402
0
$48.36
$0.00
PAID BY
METHOD
a RECEIPT #
§CHECK #.`
CLTD BY; ,
Total Paid forMECHANICAL: $132.97 $0.00
DESCRIPTION ,
w . « ; , ' -ACCOUNT
QTY
AMOUNT °,j
PAID ` "
PAID DATE
MULTI -SPECIES RESIDENTIAL 0-8 UNITS
101-0000-20310
0
$1,292.00
$0.00
PAID BY
" METHOD -
RECEIPT #'
CHECK #'-
.CLTD BY
Total.Paid forMULTI-SPECIES RESIDENTIAL $1,292.00 $0.00
DESCRIPTION
�a' ACCOUNT
QTY
AMOUNT . •
PAID *
PAID DATE"
NEW CONSTRUCTION PERMIT
ti 101-0000-42400
0
$567.55
$0.00
PAIDTBY " t « ;"
METHOD .'
RECEIPT # u "
i' ' .CHECK
CLTD BY
Total Paid forNEW CONSTRUCTION PERMIT: $567.55 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT:,
PAID @;
;PAID DATE
BACKFLOW DEVICE
101-0000-42401.
0
$12.09
$0.00
:' PAID BY t.
. ° ' METHOD,
_ RECEIPT '# <_.
-CHECK #' ,'e
CLTD BY
1 � •
fDESCRIPTION a
ay , :Y ACCOUNT
QTY
AMOUNT'
PAID
PAID DATE
BUILDING SEWER
101-0000-42401
0
$12.09
$0.00
PAID BY ' ,.
METHOD,.
RECEIPT#'
•-CHECK-# v
CLTD BY
'DESCRIPTION
ACCOUNT .
QTY
AMOUNT,:
�;; _ PAID
PAID DATE.
FIXTURE/TRAP
101-0000-42401
0
$205.53
$0.00 •
" PAID BY'.METHOD
RECEIPT
CHECK #
CLTD BY
DESCRIPTION:; `;
r `ACCOUNT
QTYq
'AMOUNT
+' . PAID "
PAID DATE
GAS SYSTEM, S+, OUTLETS
101-0000-42401
0
$36.26
$0.00
PAID BY w>
METHOD
`RECEIPT #. `
:°CHECK # f
CLTD.BY
DESCRIPTIONt++`;� ,, �'
ACCOUNT '
°QTY
AMOUNT .��
PAID t�"
PAID�DATE
WATER HEATER/VENT
101-0000-42401
0
$12.09
_ $0.00
�. PAID BY - _
METHOD
RECEIPT #.-'
CHECK #
CLTD BY
DESCRIPTION.
ACCOUNT- ' , _
,QTY :
f, ` AMOUNT
PAID'; _
(PAID DATE
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.09
$0.00
t w' PAID BY'. r `:
METHOD
RECEIPT #,
± _ ,CHECK #' �'.
CLTD BY
r
Total Paid for PLUMBING FEES: $290.15 $0.00
DESCRIPTION' '
f ACCOUNT
QTY•
"AMOUNT
PAID
`° PAID DATE
SMI - RESIDENTIAL
101-0000-20308
0
$23.71
$0.00
PAID BY _
METHOD
RECEIPT # . ` a a
CHECK # f,
-CLTD BY;
Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $23.71
DESCRIPTION ` ,;
,"ACCOUNT F +
QTY
-'AMOUNT
PAID
PAIDMATE
SINGLE FAMILY DETACHED
` 224-0000-20320
0.
$1,837.44.
$0.00
r :a PAID BY
`' METHOD' ;
RECEIPT # ., ,
ti. CHECK #
CLTD BY
Total Paid forTUMF - RESIDENTIAL: $1,837.44 $0.00
• 00
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Rk
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.: ^.vF...: r-. .i, ...v "i::l,x. �Ri.: " :-�_?H 'y5�, �N.:.vn' & ' .? :. �:g9y�. ':.ct� v ."s. 'J' h 'i?' ..-_..-^.'.:vx '�::c x- :r. �.. v?}ss :.' d.x rsm :2tc.' £._g
,lh, .... .. "�.x. x 5 .. _ .. ...., xt' :.:.x:::� .hr 'AT+.�'. 4.hv y:.,Rnd iie,: 3* ,,A.:. £ 4 :. ,iT'.' '� v.*:.
.::,.. r , a'METHOD ¢' PAID BY' �s�
PAID PAID DATE RECEIPTS#
. x k
000.UNT ti a.
DESCRIP q ..
5 :. �£'. .w '.a6 v.�W �,.. i. �.'ka rreY ,i'!fh .�i,:'v:` <. :.lf'da..-��5..@C ,o s�d.4lti�'b35Rbrd..,F,_:��.,,
�x�"Cn iry
e•�k�"a.if:�..--"v,
. .: &::� ska Y,_.,. d'9@L�....'�hi'-:--u+,_..ff:tVt-..
BSAS SB1473 FEE 101-0000-20306 0 $8.00 $0.00
Total Paid for BUILDING STANDARDS ADMINISTRATION $8,00 $0.00
BSA:
DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $0.00
DIF - COMMUNITY
254-0000-43200
0
$129.00
$0.00
CENTERS
DIF - FIRE PROTECTION
257-0000-43200
0
$433.00
$0.00
DIF - LIBRARIES
253-0000-43200
0
$344.00
$0.00
DIF - PARK
256-0000-43200.
0
$40.00
$0.00
MAINTENANCE
DIF - PARKS/REC
251-0000-43200
0
$2,048.00
$0.00
DIF - STREET
255-0000-43200
0
$116.00
$0.00
MAINTENANCE
DIF - TRANSPORTATION
250-0000-43200
0
$2,842.00
$0.00
Total Paid forDIF - SINGLE FAMILY DWELLING $6,894.00 $0.00
TEMP POWER SERVICE
101-0000-42403
0
$24.17
$0.00
Total Paid for ELECTRICAL: $24.17 $0.00
RESIDENTIAL, EA
101-0000-42403
0
$36.99
$0.00
ADDITION 1,000SF
RESIDENTIAL, FIRST
101-0000-42403
0
$145.03
$0.00
1,0006F
Total Paid forELECTRICAL- NEW CONSTRUCTION: $182.02 $0.00
CONDENSER/COMPRES
101-0000-42402
0
$36.26
$0.00
SOR
EXHAUST HOOD
101-0000-42402
0
$12.09
$0.00
FURNACE
101-0000-42402
0
$36.26
$0.00
Printed: Friday, February 20, 2015 3:01:04 PM 2 of 4 ,117 1«�
DESCRIPTION;
.ACCOUNT
QTY
AMOUNT
PAID' .a�
'P,AID'DATE�
:RECEIPT #
CHECK:#.
_
METHOD
IRT
CCTD
VENT FAN
101-0000-42402
0.
$48.36
$0.00
Total Paid for MECHANICAL: $132.97 $0.00
MULTI -SPECIES
RESIDENTIAL 0-8 UNITS
g ". t
$1,292.00
$0.00
`�,:'' '.".,,.`."•.-" �..-.ice::. '3... L'a'°+Fi�w'�,i''?W
``;;..A"..,3�.?`
Total Paid forMULTI-SPECIES RESIDENTIAL- $1,292.00 $0.00
+n^-'".' .i'::.+-'- �..a#�t: a#�
101-0000-42400
0
DESCRIPTION;
.ACCOUNT
QTY
AMOUNT
PAID' .a�
'P,AID'DATE�
:RECEIPT #
CHECK:#.
_
METHOD
K,
`.. PAID;BY
CCTD
VENT FAN
101-0000-42402
0.
$48.36
$0.00
Total Paid for MECHANICAL: $132.97 $0.00
MULTI -SPECIES
RESIDENTIAL 0-8 UNITS
101-0000-20310
0.
$1,292.00
$0.00
Total Paid forMULTI-SPECIES RESIDENTIAL- $1,292.00 $0.00
NEW CONSTRUCTION
PERMIT
101-0000-42400
0
$567.55
$0.00
Total Paid forNEW CONSTRUCTION PERMIT: .,$567.55 $0.00
BACKFLOW DEVICE
101-0000-42401
0
$12.09
$0.00
BUILDING SEWER
101-0000-42401
0
$12.09
$0.00
FIXTURE/TRAP
101-0000-42401
0
$205.53
$0.00
GAS SYSTEM, 5+
OUTLETS
101-0000-42401
0
$36.26
$0.00
WATER HEATER/VENT
101-0000-42401
0
$12.09
$0.00
WATER SYSTEM
INST/ALT/REP
101-0000-42401
0
$12.09
$0.00
Total Paid for PLUMBING FEES: $290.15 $0.00
SMI - RESIDENTIAL
101-0000-20308
0
$23.71
$0.00
Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $23.71 $0.00
SINGLE FAMILY
DETACHED
2240000-20320
n
$1,R'47."
$n M
.
Total Paid forTUMF - RESIDENTIAL: $1,837.44 $0.00
9Am ImamM
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VAttachmen t T `" a
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REVIEW Tly
REVIEWER
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SCHOOL FEE RECEIPT 2-
SCHOOL FEE RECEIPT 2-
DOC
2/19/2015
STEPHANIE KHATAMI
0
19-15.pdf
19-15.pdf
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