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BRES2017-012878-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BRES2017-0128 Property Address: 48760 SAN VINCENTE ST APN: 646140031 Application Description: TOUSSOUN / ADD GUETS SUITE Property Zoning: Application Valuation: $60,000.00 Applicant: SOUTH WEST CONCEPTS, INC. 78115 CALLE ESTADO, SUITE 105 LA QUINTA, CA 92253 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: T TOUSSOUN P 0 BOX 1825 LA QUINTA, CA 92253 Contractor: DONLEY VAN MALSEN 49578 AVILA DR LA QUINTA, CA 92253 LIC. No.: 1001901 Date: (760)578-3889.13 7%31/2017 w if O N Fw z o �z COD I w p � z D 1 Z LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations: 9 {commencing with Section 7000) of Division 3 of a Bu 'ness and Professions Code, ' I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance License lass: B License No.: 1001 Ol of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by 3 6I Contract Section 3700 of the Labor Code, for the performance of the work for which this permit 1 is issued. My workers' compensation insurance carrier and policy number are: OWNER -BUILDER DECLARATION Carr' MPT Policy Number: _ I hereby affirm under penalty of perjury that I am exempt from the Contractor's State V??certfv in the performance of the work for which this permit is issued, I .License Law for the following reason (Sec. 70315, Business and Professions Code: Any hall not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if uld become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 37 0 of th Labor Code,WL-5hallfo'th signed statement that he or she is licensed pursuant to the provisions of the comply with those provisions. Contractor's State License Law (Chapter 9 (commencing with Section 7000) of DivisionJ' '3 of the Business and Professions Code) or that he or she is exempt therefrom and th Date: 3 d/ %Applic 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO (_) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF compensation, will do the work, and the structure is not intended or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose (_) I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or . the Contractors' State License Law.). following issuance of this permit. (_) I am exempt under Sec. B.&P.C. for this reason 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. 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: Lender's Address: 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 s lating to building construction; and hereby authorize representatives of this ci to ente h above-mentioned prop rty for inspection purposes. -�% ,A�V ignature (Applicant or Agent):. Date: 7/31/2017 Application Number: BRES2017-0128 Owner: Property Address: 48760 SAN VINCENTE ST T TOUSSOUN APN: 646140031 P 0 BOX 1825 Application Description: TOUSSOUN / ADD GUETS SUITE LA QUINTA; CA 92253 Property Zoning: Application Valuation: $60,000.00 Applicant: Contractor: SOUTH WEST CONCEPTS, INC. DONLEY VAN MALSEN 78115 CALLE ESTADO, SUITE 105 49578 AVILA DR LA QUINTA, CA 92253 LA QUINTA, CA 92253 (760)578-3889 --------------------------------------------------------------------------------------------- Llc. No.: 1001901 Detail: 857 SF GUEST SUITE ADDITION (SITTING ROOM, BEDROOM & BATH) ATTACHED TO. MAIN DWELLING IN ELECTRICAL, LIGHTING, PLUMBING AND MECHANICAL. ABANDONMENT OF EXISTING SEPTIC SYSTEM AND INSTALLATION OF NEW SEPTIC SYSTEM. THIS PERMIT DOES NOT INCLUDE POOL EQUIPMENT RELOCATION OR BLOCK WALLS. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT ADDITION, EA ADDITIONAL 500 SF 101-0000-42400 0 $130.72 -DESCRIPTION ACCOUNT QTY AMOUNT ADDITION, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $36.48 DESCRIPTION ACCOUNT QTY AMOUNT t ADDITION, FIRST 100 SF 101-0000-42400 0 $127.68 DESCRIPTION ACCOUNT QTY AMOUNT ADDITION, FIRST 100 SF PC 101-0000-42600 0 $179.36 Total Paid for ADDITION: $474.24 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES ADMINISTRATIVE STAFF 101-0000-42600 0.25 $10.00• DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER 101-0000-42600 1.5 $142.50 Total Paid for BLDG CITY STAFF - PER HOUR: $152.50 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $3.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $3.00 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 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES/FIXTURES, ADDITIONAL 101-0000-42403 0 $98.67 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES/FIXTURES, ADDITIONAL PC 101-0000-42600 0 $24.57 Total Paid for ELECTRICAL: $173.90 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $38.00 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE 101-0000-42402 0 $38.00 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE PC 101-0000-42600 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $25.34 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $10.14 . Total Paid for MECHANICAL: $162.14 DESCRIPTION ACCOUNT QTY AMOUNT FIXTUREITRAP 101-0000-42401 0 $38.01 DESCRIPTION ACCOUNT CITY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $38.01 DESCRIPTION ACCOUNT CITY AMOUNT GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT CITY AMOUNT GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $25.33 DESCRIPTION ACCOUNT CITY AMOUNT SEPTIC SYSTEM 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT CITY AMOUNT SEPTIC SYSTEM PC 101-0000-42600 0 $5.07 DESCRIPTION - ACCOUNT CITY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $7.60 DESCRIPTION ACCOUNT CITY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12•.67 DESCRIPTION ACCOUNT CITY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.67 Total Paid for PLUMBING FEES: $177.37 DESCRIPTION ACCOUNT CITY AMOUNT SMI - RESIDENTIAL 101-0000-20308. 0 $7.80 Total Paid for STRONG MOTION INSTRUMENTATION SMI:, 57.80 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00