11-0442 (RC).oa :i
_ P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 11-00000442
Property Address: 77692 TRADITION DR,
APN: 658-130-011-12 -31379 -
Application description: REMODEL - COMMERCIAL
Property Zoning: LOW DENSITY RESIDENTIAL.
Application valuation: 1000
Applicant:
BUILDING & SAFETY DEPARTMENT
'BUILDING PERMIT
Owner:
ROSS BRIAN'
77692 TRADITION #262
LA QUINTA, CA 92253
(000)717-8233
Contractor:
Architect. r E gi ear: NICHOLAS INC, TD
BOX I
WIL CA
WILDOMAR, CA 92595
(951)245-2559
Lic. No.: 581497
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:. 5/02/11
i
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 Professionals ode, 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 ansa No.: 581497
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
\'.Date:
issued. "
Contractor:'
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
• OW R -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,_, _ _: r>.«�
Carrier EVEREST NATL Policy Number 7600006962111
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county tht-re ues a pCfg(&`"•�:.r•� `7
i
_ I certify that, in the performance of the work for which this permit is issued, I shall not employany
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also r the pfica�it, the_°;�---•� "
person in any manner so as to become subject to the workers' compensation laws of California,
squires
permit to file a signed, statement that he or she is licensed pursuant to the provisions of�the Contra: torsSrat�
y and. agree that, if I should become sub'ect to a workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
t
3700 of the Labor Code, I shall f ply with those provisions. `
`�
. that he or she is exempt therefrom and the basis for the alleged exemption. Any violati4tn of ction t7 P!5 by-
" any applicant for a permit subjects the applicant to a civil penalty of not more than five N r dr i1 dollaY �j DO)( �-1 I'
1 1 I, as owner of the property, or my employees with wages as their sole compensafio� 1 dl do t e work, and
e: Applicant: "
_
the structure is not intended or offered for sale (Sec. 7044, Business and Profgs i. Code: The
' Contractors' State License Law does not apply to an owner of property who bYil r,improves #Aereon, '
W( j11IIVG: FAILURE TO SECURE WORERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL ,
S T AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her'own employees, {i o i d that the'�'
—DOLT—ARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sate. If, however, the building or� r vemeniniswithin
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
one year of completion, the owner. -builder will have the burden of proving that lie she did not build or
-
' improve for the purpose of sale.).
- APPLICANT ACKNOWLEDGEMENT
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors'. State License Law does not apply to an owner of -
conditions and restrictions set forth on this application. '
property who builds or improves thereon, and who contracts.for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
' pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason
' -
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City.
of La Quinta its officers a ants and emP to ees for am, act or omission related to the work being
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'sAddress:
LQPERMIT
• 9 Y
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 i correct. I.agree to comply with all
city and county ordinances and state laves relating to building coVns,,on,dherebyauthorize representatives
of this county to'enter upon the above-mentioned property fooses. "
Date:. Signature (Applicant or Agent):
Application Number 11-00000442
Permit . . . . BUILDING PERMIT
Additional desc .
Permit Fee' 25.00 Plan Check
'Fee
16:25 y
Issue.Date . . . . Valuation
1000
Expiration Date 10/29/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
- 5.00. 2.0000 HND BLDG'501-2,000
----------------------------------------------------------------------------
10.00
Permit . . . PLUMBING
Additional desc .
Permit Fee . . . 21-00 Plan Check
Fee
5.25 .
Issue'Date Valuation
. . .
. 0
Expiration Date 10/29/11
Qty Unit.Charge Per.
Extension.
-BASE FEE
15.00
1.00 6.0000 EA PLB FIXTURE
6.00
Special' -Notes and .Comments'
REPLACE DOUBLE LAYER 5/8 DRYWALL MASRER.
BATH 2' X 41. MASTER CLOSET 4' X 5'
INSTALL NEW SHOWER PAN APPROVED PER S.T.
----------------------------------------------------------.----
Other'Fees BLDG STDS ADMIN (SB1473)
------ - - - - -- -
1.00
Fee summary Charged Paid' Credited
Due
' Permit Fee Total 46.00 00
.00
46.00
Plan Check Total 21.50 .00
.00
21.50•
Other Fee Total 1.00 .00
.00
1.00
Grand Total 68.50 ..00
.00
68.50
LQPERMIT
Bin #
",Qty of 1a Quinta
:Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: —77-6f 4 jZ��
Owner's Name:
A. P. Number:r
Address: 7—�j Z �aDrt Z.6�
Legal Description:
Contractor: �• �
City, ST, Zip: ZX CUMMA Z �3
Telephon ZfQ L ZS J
Address: / 3
Project Description:
City, ST, Zip: �L�Z2�iyl� C�f� LS%G
a
Tele hon
P g J Z'�S �%�
.'. ��•L;f .•., •: iti:•. Oi �:;:�i:,>.;:jti?iii}:v}?}•S:
.>;;�;j:s:;>.:«:;::•s;s::�:?�::'>::>:::::::<::<>«:?<>
d�/yA;l,s'T�� GZOj�i�•��X.) — //V �T1 C.L..
State Lic. # :
City Lic.•#;
;PA3 .
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone::<>:;:>:<:>
• <:s-?ire?<?:<s::'<:':<,:>:
Con struction Type: Occupancy:
State Lic. #:
Project tYP (circleone): New Add'n , AlterRepair Demo
Name of Contact Person: ��11 �i�.f-lOGtCi!
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Perso ,57 937—.0 �j
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs..
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2". Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
)
Grant Deed
Plans picked up,
S.M.1.
H.O.A. Approval
Pians resubmitted
Grading
IN. HOUSE:
"d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub.'Wks. Appr
Date of permit issue
School Fees
Total Permit Fees