BSPN2017-0006Applicant:
MITCHELL WICHTER
243 VIA SAN LUCIA
RANCHO MIRAGE, CA 92260
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 Professions Code,
and my License is in full force and effect.
License Class: _ License No.:
Date: Contractor:
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, after, 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
($500).:
(_) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees,.provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does riot apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(_) I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's
VOICE (760) 77.7-7125
FAX (760) 777-7011
TIONS (760) 7774153
Owner: U)AfV ,2 5 toil
MICHAEL C 0
78860 SAN A DR wCjT i F QUINTA
LA QUINTA O'ja 2S$CEVELOPMENTOEPARTtIENT
Contractor:
LIC. No.:
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: _ Policy Number: _
I certify that in the performance of the work for which this permit is issued,
shall not employ any person in any manner so as to b�Id
e subject the workers'
compensation laws of California, and agree that�370,
i sh beco subject to the
workers' compensation provisions of Sectiono he Labor ode, I shall forthwith
comply with those provisions. / _
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 abo i orma on is correct.
I agree to comply with all city and county ordinances ands a IVs rel ing to building
construction, and hereby authorize representatives of th' ci me upon the
above-mentioned property for inspection purposes.
Ct J4ie/
78-49S CALLE TAMPICO
0 D
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BSPN2017-0006
Property Address: 78860 SANITA DR
APN: 604163011
Application Description: COOK RESIDENCE / SPECIAL INSPECTION
Property Zoning:
Application Valuation:
Applicant:
MITCHELL WICHTER
243 VIA SAN LUCIA
RANCHO MIRAGE, CA 92260
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 Professions Code,
and my License is in full force and effect.
License Class: _ License No.:
Date: Contractor:
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, after, 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
($500).:
(_) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees,.provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does riot apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(_) I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's
VOICE (760) 77.7-7125
FAX (760) 777-7011
TIONS (760) 7774153
Owner: U)AfV ,2 5 toil
MICHAEL C 0
78860 SAN A DR wCjT i F QUINTA
LA QUINTA O'ja 2S$CEVELOPMENTOEPARTtIENT
Contractor:
LIC. No.:
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: _ Policy Number: _
I certify that in the performance of the work for which this permit is issued,
shall not employ any person in any manner so as to b�Id
e subject the workers'
compensation laws of California, and agree that�370,
i sh beco subject to the
workers' compensation provisions of Sectiono he Labor ode, I shall forthwith
comply with those provisions. / _
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 abo i orma on is correct.
I agree to comply with all city and county ordinances ands a IVs rel ing to building
construction, and hereby authorize representatives of th' ci me upon the
above-mentioned property for inspection purposes.
Application Number: BSPN2017-0006
Property Address: 78860 SANITA DR
APN: 604163011
Application Description: COOK RESIDENCE / SPECIAL INSPECTION
Property Zoning:
Application Valuation:
Applicant:
MITCHELL WICHTER
243 VIA SAN LUCIA
RANCHO MIRAGE, CA 92260
Owner:
MICHAEL COOK
78860 SANITA DR
LA QUINTA, CA 92253
Contractor:
Date: 1/25/2017
Llc. No.:
---------------------------------------------------------------------------------------------
Detail: SPECIAL INSPECTION FOR PERMIT 14384 THAT WAS AN ADDITION 312 SF THAT WAS NEVER FINALED.
't. 'k Y '
1 , • 1 •''
DESCRIPTION �• ;.
ACCOUNT'.. R. '' 1 -QTY
AMOUNT
SPECIAL INSPECTION
101-0000-42404 0
$76.00
DESCRIPTION
ACCOUNT QTY
AMOUNT '
SPECIAL INSPECTION PC
�. 101-0000-42600 0
$190.00
Total Paid foreCOMPLIANCE SURVEY/SPECIAL INSPECTION:
$266.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT E
FE
`'502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00
- r
s
- 1n'
f
5
S
A
Jain if
Permit #
roject Address: 7
�/ .
City of Lj Quinta
Building $t Safety Division'
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
p / /� a;
0 6 .G iv^ ` `lG �Jr . ratvner s Name: %i . G
�� rr �' CG
A. P. Nwnber:Adds:
Legal Description:
%� 4i 4•SQT> zip: (;/l�..� n f 1 �' C c' gJ S
Contractor:
Address:N'
Project Description: 119GPd,•
City, ST, Zip:
Telephone:
one:
State Lic. # :
City Lie. #t
Arch.,'Engr:, Designer:
Address:
City, ST, Zip-
ip:
TelP
Telephone.
e hone:
.... .......
........... .....:..:...
. Construction Type: : OccuP cY•
State to Lic. #
oJect tYPrPe (circle one • New Add'n Alter r Re ai r Dem
F Nf Contact Person:
/fin
e,�
Sq. Ft.:
#Stories:
#Units:
I. Telephone # of Contact Person: 2 LNa
,r of ated.�Value of Project: � jl,�/.. (J 00
APPLICANT: DO NOT,WRITE•BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING:
PERMIT FEES
Plan Sets
Plan Check submitted.
Item
Amount
Structural Cafes..
Reviewed, ready for'corrections
Plan Check Deposit
Truss Calcs.
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 .
SubcontactorList
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M..L
II.O.A. Approval
Plans resubmitted,
Grading
IN If OUSE:-
'"! Review, ready for correct ionsrtssuC.
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
.
-Total Permit-Fecs
r 1' 7 6^ `j C%
4-7
74
�cC_ 1
<�,_& e- /C
-