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BRES2016-035478-495 CALLE TAMPICO - LA QUINTA, CALIFORNIA 92253 Application Number: BRES2016-0354 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Property Address: 52675 AVENIDA VELASCO APN: 773294020 . Application Description:_ ORTIZ RESIDENCE / FIRE RESTORATION Property Zoning: Application Valuation: $20,000.00 Applicant: ' JUAN PEREZ C N PO BOX 1868 LA QUINTA, CA 92.253 LA QUINTA, CA 92253 oo LICENSED CONTRACTOR'S DECLARATION I 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 Professions Code, and my License is in full force and effect. License Class: C-9.pB License No.: 956037 Date: L.2 1 ro Contractor:. 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.). (� 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 contractors) 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: VOICE (7 60) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Da016 z Owner: s NEREIDA ORTIZ 52675 AVENIDA VELASCO 0 C N z c LA QUINTA, CA 92.253 p� oo + c J � U� Contractor: MAC DONALD SERVICE GROUP INC $A31p1)� c� 72-104 CORPORATE WAY' THOUSAND PALMS,. CA 92276 (760)343-3933 Llc. No.: 956037 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. 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: GRANITE STATE INSURANCE COMPANY Policy Number: WC065259913 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 Code, I shall forthwith comply with those provisions. Date: 1.2 . Applicant: 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 Building Official 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. e 1 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 city to enter upon the above-mentioned property for inspection purposes. Date: "�! �� Signature (Applicant or Agent): Date: 12/29/2016 Application Number: BRES2016-0354 Owner: Property Address: 52675 AVENIDA VELASCO NEREIDA ORTIZ APN: 773294020. 52675 AVENIDA VELASCO Application Description: ORTIZ RESIDENCE / FIRE RESTORATION LA QUINTA, CA 92253 Property Zoning: Application Valuation: $20,000.00 Applicant: Contractor: JUAN PEREZ MAC DONALD SERVICE GROUP INC DBA FLOOD R PO BOX 1868 72-104 CORPORATE WAY LA QUINTA, CA 92253 THOUSAND PALMS, CA 92276 (760)343-3933 • LIc. No.: 956037 Detail: FIRE RESTORATION - GARAGE ONLY 480 SF. INTERIOR ONLY. PER 2013 CALIFORNIA BUILDING CODE FINANCIAL .• i. DESCRIPTION ACCOUNT. CITY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:' $1.00 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $152.00 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $50.16 Notal Paid for ELECTRICAL - NEW CONSTRUCTION: _ $202.16 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT ' 101-0000-42401 0. $12.67 DESCRIPTION ACCOUNT CITY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $7.60 Total Paid for PLUMBING FEES: $20.27 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, EA ADDITIONAL 500 SF 101-0000-42400 0 $22.80 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $18.24 DESCRIPTION ACCOUNT- CITY AMOUNT REMODEL, FIRST 100 SF 101-0000-42400 0 $51.68 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, FIRST 500 SF PC 101-0000-42600 0 $141.36 Total Paid for REMODEL: $234.08 DESCRIPTION ACCOUNT CITY AMOUNT SMI —RESIDENTIAL 101-0000-20308 0 $2.60 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $2.60 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611. 0 $5.00 Total Paid. for TECHNOLOGY ENHANCEMENT FEE: $S.00 Bin ## VI . arty of La Quinta Building U Safety Division Permit #i . _ 78-495 Cafe Tampico La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet Project Address: Sa �-7 A c t, -VT(-11-SCO. Owner's Name: Z �— A. P. Number: 1 , ' O D -C) Address: C NIS Legal Description: r G' --T_ o City, ST, Zip: Contractor: LaT � 1 �l 5 Telephone: Address: Project Description: <::3�YZ- -7- city. ST, Zip: Telephone: le h Po . r -'YT �L s .4.r `T •2 0 State Lic. # : City Lic. #.: 09, Arch., Eng Address: O 6 City, ST, Zip: (� fQ_ V/ - c3c3k Telephone: 6o 6 M7 S structton Type: Occupancy: cY: ,. Sta toL ic. # roJect type circle ne • New Add'n Alter r tr mo e a e Name of Contact Person: ��72- Sq. Ft.: �� # Stories: # Units: Telephone # of Contact Person: 6Q• 6 (q • %j a- Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Cafes. Called Contact Pcrson Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review, ready for corrections/issue Electrical . Subcontactor List Called Contact -Person Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN IiOUSE:- Jrd 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