12-0102 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tit!t °F 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner: i
BRIAN DOREY v
48765 CLASSIC DRIj
LA QUINTA, CA 9225
Contractor:
Applicant: Architect or Engineer: NICHOLAS INC, TD
P.O. BOX 1543
• t WILDOMAR, CA 92595
(951)245-2559
Lic. No.: 581497
1�
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
CATV OF IA >:fCiN :A
2/06/12
s`
----------------=------------------------------------------ -------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury than) am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals and my License is in full force and effect.
License Class: B kens o.: 581497
D e: Z C tractor 1
ON - UILDER 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).:
(_ 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 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 not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(sl 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
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 EVEREST NATL Policy Number 7600006962111
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 wor rs' compensation provisions of Section
3700 of the Labor Code all forthwith cc m with se provisions.
Sete:ca
WARNING: FAIL EUiCRE ORKERS' COM TIO COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT, AN EMPLOYER TO C INAL 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 her thorize representatives
ofhis county to enter upon the above-mentioned prope ction purpo
Date : ignature (Applicant or Age
_--_.7
Application Number:
12-00000102''''--_�
Property Address:
-'48765 CLASSIC DR
APN:
658-130-011-5 -313.79 -
Application description:
REMODEL - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
12500
Tit!t °F 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner: i
BRIAN DOREY v
48765 CLASSIC DRIj
LA QUINTA, CA 9225
Contractor:
Applicant: Architect or Engineer: NICHOLAS INC, TD
P.O. BOX 1543
• t WILDOMAR, CA 92595
(951)245-2559
Lic. No.: 581497
1�
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
CATV OF IA >:fCiN :A
2/06/12
s`
----------------=------------------------------------------ -------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury than) am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professionals and my License is in full force and effect.
License Class: B kens o.: 581497
D e: Z C tractor 1
ON - UILDER 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).:
(_ 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 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 not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(sl 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
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 EVEREST NATL Policy Number 7600006962111
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 wor rs' compensation provisions of Section
3700 of the Labor Code all forthwith cc m with se provisions.
Sete:ca
WARNING: FAIL EUiCRE ORKERS' COM TIO COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT, AN EMPLOYER TO C INAL 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 her thorize representatives
ofhis county to enter upon the above-mentioned prope ction purpo
Date : ignature (Applicant or Age
Application Number . . . . . 12.-00000102
Permit . . . BUILDING PERMIT
-
Additional desc .
Permit Fee . . . . 144.00 Plan Check
Fee
93.60
Issue Date . . . . Valuation
. . .
. 12500
Expiration Date 8/04/12
Qty- Unit Charge Per
Extension
BASE FEE
45.00
11.00 9.0000 THOU -BLDG 2,001-25,000
99.00
---------------------------------=------------------------------------------
Special Notes and Comments
RE -INSULATE EXTERIOR WALLS R-19, CEILING
THROUGHOUT WITH R-30 FOR SOUND & PARTY
WALLS WITH R-13 FOR SOUND. RE -DRYWALL
ENTIRE UNIT WITH TYPEX 5/8. 2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . . .. . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 144.00 .00
.00
144.00
Plan Check Total 93.60 .00.
.00
93.60
Other Fee Total. 1.00 .00
.00
1.00
Grand Total 238.60 .00
.00
238.60
LQPERMIT -
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LA QU!NTA
CITY OF
BUILDING & SAFETY DEPT.
APPROVED
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BuMig a Safety Divfcion .
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Perrnit #
Project Address: ye^ 70S �G 0—
Owner's Name:.
A. P. Number.
Address:
Legal Description:
Contractor. n G
City, ST, Zip:
H
Telephone
Address: 40.— 3
Project Description:
City, ST, Zip: i
Telephon : 4 -4 J/ ��2-- 'Y7(e r Gail r7 r - -ap-rv& cJ U Agayjr
State Lic. # : Cj City Lic. #, —�
.
Arch.; Engr., Designer. i'l IJ6 C . � : ` ^/'' �! H [� s
Address:
City., ST, Zip:
Telephone: Construction Type:. Occupancy:
State Lic. #: Project type f circle one): New Add'a Alter Repair Demo
Name of Contact Person: Sq. Ft.: # Stories: #Units:
Telephone # of Contact Person: Estimated Value of Project: �z
APPLICANT: DO NOT WRITE BELOW THIS LINE
p Submittal Req'd Recd TRACKING PERMrrFEES-
Plan Sets Plan Check submitted Item Amount
Structural Cates.
Reviewed, ready for corrections Plan Check Deposit. .
Truss Calcs.
Called Contact Person Plan Check Salanee,
Title 24 Calm
Plans picked up Construction
Flood plain plan
Pians resubmitted.-. Mechartical
Grading plan
2id Review, ready for correctionsfissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plans resubmitted Grading
IN ROUSE:-
3a Review, ready for correcdonsfissue Developer Impact Fee
Planning Approval
Called Contact Person AXP -P -
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees