13-0896 (SPIN)r
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00000896
Property Address: 53830 AVENIDA JUAREZ
APN: 774-151-004-21 -000000-
Application description: SPECIAL INSPECTION
Property Zoning: COVE RESIDENTIAL
Application valuation: 250
Applicant:
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WILLIAMS THOMAS M
53830 AVENIDA JUAREZ
LA QUINTA, CA 92253
LICENSED CO RACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lic ed nder provisions of Cha��{{er 9 (commencing with
Section 7000) of Division 3 of Business and P fes ' n, s de, and my Liq�ns96 is in full force and effect.
License Class: ens o.: �� ��
v 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).:
(_) 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.).
(_ 1 1, 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: _
Lender's Address:
LQPERMIT
Contractor: /r"J
Owner 1 I
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
JUL 17 2013
------
Date: 7/16/13
W PKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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.
ave 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, I shall not employ any
person in any manner so as to b e su - to the workers' nsation laws of California,
and agree that, if I should b me bject o t workers' c pens ion provisions of Section
3700 of the L or Code, It thwith ompl with tho provi ons.
Dat5, !- Applicant:
WARNING: FAILURE TO SECUR ORKERS'COMPENSATIO6 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 Director of Building and Safety 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.
1 certify that I have read this application and state§tobuilding
the above i r is c r t. 1 agree to comply with all
city and county ordinances and state laws relating co tru n and ereb uthorize r re motives
of thiscouter upon the above-mentionedrty fo nsp urpo s.
Date: (! Signature (Applicant or Agen
-=.
Application Number .
. . . . 13-00000896
Permit . . . . .
SPECIAL INSPECTION
Additional desc
'
Permit Fee . . . .
71.50
Plan Check Fee
.00
Issue Date
Valuation
250
Expiration Date
1/12/14
Qty Unit Charge
Per
Extension
1.00 71.5000
EA MISC
SPECIAL INSPECTION
71.50
Fee summary Charged
---------------------------
----------
Paid Credited
--------------------
Due
Permit Fee Total
71.50
.00 .00
71.50
Plan Check Total
.00
.00 .00
.00
Grand Total
71.50
.00 .00
71.50
L
r
LQPERMIT
Bin #
City of La Quinta
Building BT.Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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Project Address: -30 D'I 1iJake
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: L-),,`t;j,4 wJ,,_ .. � c.') ✓v •tom S
Telephone: :>.'• ? > <: h: «<:? >'< <: > <:i:
Address: —7—
Project Description: A
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City, ST, Zip: P4 �vh . l� ��)
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Telephone:>'sf:?<`:<::'
State Lie. # :
City Lie. #.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
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Construction Type: Occupancy:
State Lie. #:
project type (circle one): New Add n Alter epair Demo
Name of Contact Person: �L� ,
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal l
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted'
Mechanical
Grading plan
2°" Review, ready for corrections/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for correctionsfissue .
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees