13-1285 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description
Property Zoning:
Application valuation:
Applicant:
I
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
13-00001285 Owner:
50920 CALLE PALOMA DISTAN UNITED, LLC.
770-103-005-62 '-000000- 5:0-920 CALLE PALOMA
REMODEL -'RESIDENTIAL QUINTA, CA 92253
LOW DENSITY RESIDENTIAL (� a
9000 U y
3 ntractor:
Architect or Engineer: pCT 2 209JNCAN CONSTRUCTION
20 WILSON•ROAD
OVERDALE, CA 95425,
760) 564-89.05
Lic. No.:'315962 -
v`FIRIAIVCE'
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury tha licensed_ under provisions of Chapter 9 (commencing with
Section 7000) of'Division 3.of-the Busin s'an Prof s ' als Code, and my License is in full force and effect..
License Class: B License No.: 315962 '
D, V a _ .�� Contractor:
NER-BUILDER.DECLARATION
I hereby affirm under penalty.,of perjury that I am exempt •from the Contractor's State License Law for the .
following reason7Sec. 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; pursuantto the provisiousof the Contractor's State* .
License Law (ChabiW,,9 (commencing. with Section 7000) of Division 3 of tlie'Business,and Professions Code) or
-.that he or she is exempt,therefrom,and the, basis for=tRe alleged exemption. -'Any violation of Sectiori'7031 5 by
any apphcarit:for -a permit subjects the applicant to a civil penalty -of not more than five.hundred dollars ($500).:, .
(_) I,,aslowneryof'the-property,,or my employees with .wages as their_sole�compensation, will do the work, and -
.ihe structure'is not intended or.offered for sale (Sec.,7044,-Business and Professions Code: The
.°Contractors' State License l-aw does not apply to an:owner of `property who builds or. improves thereon,
and who�does the work himself or herself throughhis.or her-own;eniployees;. piovided thatthe.:•
improvements are not intended'oroffered for sale:-lf,.however,. the: buildingor improvement is'sold within
one year of completion,'the owner -builder will have the.burdenof 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.
70_44, 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'i6 projects with�a contractors) licensed..
pursuant to the Contractors' State License Law.).
1 _ 1 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: —
Lender's Address:
LQPERD1IT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/25/13
-
--------------------------------------------—
WORKER'S COMPENSATION DECLARATION
'I herebyaffirm under penalty of.perjury one of the following declarations: '� . • i
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
for by Section 37,00 of the Labor Code, for the performance of the work for which this permit - is -
issued.. r.
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' -compensauon
insurance'carrier, and'policy.'num_ berare:.,-
Carrier EXEMPT Policy Number EXEMPT
I certify that,. in the performance of the.work.for which this permit is issued; I shall not employ anytt'
'person in.any mannei, to:bbcome subject to the workers' compensation laws of California :k
and agree that rf I' o'id ecome subject to thejkers compensation provisions ofSection 3700 of the Labo•Code 11 forthwit mph'those'provisions.
Date: � �! y,Applicant: r
WARNING:_FAILURE TO;SECURE,W, - M COMPENS,60N COVERAGE IS. UN LAWFUL', AND SHALL
SUBJECT AKEMPLOYERTd'CRIMI,- NALTIES AND CIVIL FINES UP TVONE'IiUNDREO.THOUSAND -
DOLLARS ($100,000) IN ADDITION•TO:THE COST OF COM PEN SATION,'DAMAGES AS PROVIDED: FOR IN
SECTION 3766 �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.. - �.ar»:,�, ,
Each person upon wnosebehalf•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 actor 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 thea 'nformadiscort. I agree to comply with all
city and county ordinances and state laws relating.tobuit con tructioauthorize representatives
of this coun to nter upon the above-mentioned grope y for i coon Date / -Signature-(Applicant or AgentL ��
LQPERMIT
Application Number .
. . 13-00001285
Permit
ELECTRICAL 2013
Additional desc .
Permit Fee . . . .
23.83 Plan Check Fee
.00
Issue Date
Valuation . .
. . 0
Expiration Date
4/23/14
Qty Unit Charge
Per
Extension
1:,00 i 23.8300
--------------------
LS ELEC FIXTURES, FIRST 20.
23.83",
Permit
MECHANICAL 2013
Additional'• desc ": .
Permit Fee
23.84 P1an.Check Fee
.00
Issue Date
Valuation: . .
0.°
Expiration Date
4/23/14
Qty Unit Charge
Per '
Extens'ion.
1.00. 11;9'200
FA-,. MECH APPLREP/ALT,'
11.92
1:: 0:0" . -•11. 92.0.0"'`EA,
MECH' VENT. -FAN
11.92
Permit
PLUMBING. 2013
Additional,desc .
Permit. -Fee-
71.52 Plan' -,Check Fee
." 00
Is'sue' Date
Valuation
- 0
Expiration -Date- .:.
4/23/14
Qty Unit Charge
Per
Extension'.
3.00,-: 11-:920:0_.EA
PLBG'FIXTURE/TRAP''
"1...00,. 11.9200
.EA PLBG WATER!INST/ALT/REP
11.9.2
2.00' 11..;9200.
LS' PLBG GAS'SYS; 1-4".OUTLETS
23:84 '
Permit ".
REMODEL.2013
Additional; desc
;Permit.•Fee
70:.07- Plan:;Cheek Fee
.00
ISs*ue'.Date _
"Valuation'0
Expiration Date
4:/23/14
Qty Unit. -'Charge
Per
Extension
1:`00 48.6200'
LS" MISC REMODEL, 1ST 100 SF
48-62'`
21-c4500.EA
• . MI•SC:,REMODEL, ,'ADDL•.500 _SF . .
,: _ - 21 45:.. ;
Special, Notes and Comments.
ADD" NEW BATHROOMs''AND 'CHANGE
OUT 4
WINDOWS AND.DOORS, RELOCATE
WATER HEATER
.October 25., 2013 9':48:28
AM.''jjohnson.
Application Number
. . . . .
13-00001285
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Other Fees
BLDG STDS ADMIN .(SB1473)
1.00
,
PLAN -CHECK, ELECTRICAL
23.83
-
PLAN CHECK, REMODEL
15015
PLAN. CHECK, MECHANICAL
9.54
PLAN CHECK, PLUMBING
71:51
STRONG -MOTION (SMI) - RES
.90
Fee summary
Charged
Paid Credited
Due
Permit Fee Total
18_9:,26`
.00,, ..00`
189.26
Plan Check ,Total
.00..
00.,,
Other "Fee Total
256..,93
.00. .00
256.93
Grand Total
446:'i'9
.00 .00
446.19
LQPERMIT