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11-0343 (RER)S P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 11-00000343 48677 CLASSIC DR 658-130-011-5 -31379 - REMODEL - RESIDENTIAL LOW DENSITY RESIDENTIAL 1500 T4&t aF 4 4" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: 64w� /y,40fZA A#4A% G ©4z X53 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/14/11 Owner: 0721305 BC LTD •/ 0720761 BC LT 48677 CLASSIC DR LA QUINTA, CA 92253 D Contractor: i QV,Nyp NICHOLAS INC, TD QFti� P.O. BOX 1543 WILDOMAR, CA 92595 (951)245-2559 Lic. No.: 581497 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 is not intended or offered for sale (Sec. 7044, Business and Professions Cade: 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.). ( ) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: I 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 ISec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERAIIT Date: VApplicant: 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 yjyn�ruc on, and herauthorize representatives of this court y to enter upon the above-mentioned property fFcis cion purposes. Date: �� /Signature (Applicant or Agent ------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of.perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and PrAfessionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B License No.: 581497 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ,,� \/Date: vcontractor: _ 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 OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier EVEREST NATL Policy Number 7600006962111 following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with those provisions. 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 is not intended or offered for sale (Sec. 7044, Business and Professions Cade: 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.). ( ) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: I 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 ISec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERAIIT Date: VApplicant: 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 yjyn�ruc on, and herauthorize representatives of this court y to enter upon the above-mentioned property fFcis cion purposes. Date: �� /Signature (Applicant or Agent Application Number . . . . 11-00000343 Structure Information Construction Type . . . . . TYPE V, PROTECTED Occupancy Type . . . . . HOTEL/APT/LONG HSING >10 Other struct info . . . . . CODE EDITION ---------------------------------------------------------------------------- 2010 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 35.00 Plan Check Fee 22.75 Issue Date Valuation . . . . 1500 Expiration Date 10/11/11 Qty Unit Charge Per Extension BASE FEE 15.00 10.00 2.0000 HND „ BLDG 501-2,000 20.00 --------------- Special Notes and Comments STRUCTURAL REPAIR OF FLOOR SHEATHING, SILL PLATES AND RIM JOIST AT SECOND FLOOR UNIT MASTER SHOWER #1 PER ENGINEERED DOCUMENTS. 2010 CODES. NOTE TO CONTRACTOR: ADDITIONAL REPAIRS TO THE STRUCTURE MAY BE REQUIRED ONCE DEMO HAS OCCURRED AND MORE STRUCTURE CAN BE OBSERVED. COORDINATE WITH THE BUILDING INSPECTOR TO OBSERVE THAT SHEAR PANEL NAILING, SILL PLATE NAILING, SHEAR WALL HOLD DOWNS, ETC ARE REPLACED AS PER THE ORIGINALLY APPROVED PERMITTED STRUCTURAL PLANS. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 STRONG MOTION (SMI) - RES. .50 Fee summary. Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 35.00 .00 .00 35.00 Plan Check Total 22.75 .00 .00 22.75 Other Fee Total 1.50 .00 .00 1.50 Grand Total 59.25 .00 .00 59.25 LQPMN11T