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12-0348 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 "`&t�v - 4 XP Q" Application Number: 12-00000348 Property Address: 49475 AVENIDA CLUB LA QUINTA APN: 658-320-013- - - Application description: REMODEL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation; 4000 Applicant: Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 1 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 Professionals Code, and my License is in full force and effect. License Class: B License No.: 536992 V Date:3-b�-/ Contractor: OWNER -BUILDER DECLARATION 1 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—) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure i8 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.). (_ 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: LQPERMIT Owner: MARC E. SOUZA 54575 WINGED FOOT LA QUINTA, CA 92253 Contractor: MC KINNEY CONSTR PO BOX 1165 MORONGO VALLEY, (760)363-9110 Lic. No.: 536992 CO, VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/05/12 CA 92 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 EXEMPT Policy Number EXEMPT _ 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 become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor C , 1 shall forthwith omply with those provisions. Date• A licant: .t— 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 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. 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 laws relating to building construction, and hereby authorize representatives of this county to enterer/.flpon the above-mentioned prope r inspection purpo es. \ Date. / 6 �`r Signature (Applicant or Agent): Application Number . . . . . 12-00000348 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 63.00 Plan Check Fee 40.95 Issue Date . . . . Valuation . . . . 4000 Expiration Date 10/02/12 - Qty Unit Charge Per Extension BASE FEE 45.00 2.00 9.0000 THOU BLDG..2,001-25,000 18.00 Special Notes and Comments . REPAIR OF EXISTING CHIMNEY TO CONDOMINIUM UNIT. 2010 CODES ----------------------------- Other Fees . . . -----------------------------------=----------- . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ------------------------------ Due ----------------- Permit Fee Total ---------- 63.00 .00 .00 63.00 Plan Check Total 40.95 .00 .00 40.95 Other Fee Total 1.00 .00 .00 1.00 Grand Total 104.95 .00 .00 104..95 LQPERMIT CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUtio- I N nA Z sY ""Crow 1.7 11"N ec>co aAcxl�A4 ��t:C ' I PS-jjy+ -R F-1 f4 F0 RC4 f ??AM . * $ks E ff APPLE{' STKGCo�LAc6FINISN WITI-! TIl.EBA D urs-�a�c Ex�sTiN� Sc.14F,tvt..A,rtG POT 7-0 4 ALeF meTA L FLh51AWel 's'a pow c wALLWRAP T-E'LA65 EX1sTI 6r 46AF STAND�AGl;:€R:CH.1il�i�t "'WEN/ _� Bin.# City Of i(I11td Building 8t. Safety Divfrion . .O. P.O. Box IS04, 78-495 Calle Tampico La.Quinta, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Sheet Permit #P 3K 2 Project Adderm -� j f �, � U A. LV 1 �. 4747 Owner's Name:.�� A. P. Number /,A �� Address: -'Y '7s V f .� U. =- !� Legal Description:. City, ST, Zip: !, A'Q I J 2 Z-6-3 Contractor. Telephone: > a Address: arj D r l (/-Q Project Description: ES E' Grf f v� N S City, ST, Zip: V\.01-DA-1:1110 (f CA,0 1 b ) A f ?^ R-., Telephone. . 76o 3b3 et/ I l) 0ZArcState Lic. #: Lie. #; / Q 702- h, Engr., Designer Arch, Address: City, ST, Zip: Telephone: �. State Lic. #: �xfir: Jjy Construction Type. Occupancy: Project type (circle one): New Add'n Alte Rep o Name of Contact Person: Sq. FL: ZO # Stories: j # Units: Telephone # of Contact Person: o •p Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Retia Recd TRACMG PERMrP FEES Plan Sets Plan Check submitted ?j Item Amount Structural Cities. Reviewed, ready for corrections Plan Check Deposit. . Truss Cates. Caned Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted.. Mechanical Grading plan. 2`j Review, ready for correctionsissue — Electrical Subeontactor List Called Contact Person �� Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN ROME-'"` Review; ready for cortectionsfissue Developer Impact Fee Planning Approval Called Contact Person A.LP-P. Pub. talcs. Appr Date of permit Issue School Fees Total Permit Fees 7