12-0342 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN-
Application description:
Property Zoning:
Application valuation:
Applicant:
12-00000342
53701 AVENIDA VELASCO
774 -124 -025 -
REMODEL - RESIDENTIAL
COVE RESIDENTIAL
7000
Architect or.Engineer:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
ALEXSA GOBEL
74998 COUNTRY CLUB DR 2120-57
PALM DESERT, CA 9226.0
Contractor:
CASTLE CONSTRUCTION
` 68670 LOS GATOS
CATHEDRAL CITY, CA 92234
(760)272-4191
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:
4/12/12
,
LicNo.:675800
-
APR 2012
,
-!
+
C, -v 5r. U 7s
_
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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 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.: 675800
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Contractor�Ca� //i • (!J�!SX/ UL��G/V
_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
,//late:
-
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 STATE FUND . .Policy Number 1863381-2012 .
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) or3700
14 that he or she is exempt therefrom and the basis for the alleged exemption. • Any violation of Section 7031.5 by
of the Labor Code, I shall forthwith comply with those provisions.
,..
i
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
I�
!/ pplicant: iJf N ✓,(�'f ✓
Date: Q
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
•
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT 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, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION; DAMAGES AS PROVIDED FOR IN
- improvements are not intended or offered for sale. If, however, the building or improvement is sold within
-
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 he or she did not build or
• .
improve for the purpose of sale.). -
APPLICANT ACKNOWLEDGEMENT
(_ 1 I, 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
11. 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,
-
r
I—) 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 ouinta, its officers, agents and employees for any act or omission related to the work being
- performed under or following issuance of this permit.
Date: ' Owner:
2. Any permit issued as a result of this application becomes null and void if work is not commenced
within 160 days from date of issuance of such permit, or cessation of work for 180 days will subject
• CONSTRUCTION LENDING AGENCY -
permit to cancellation.
1 hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
matio is corr . I agree to comply with a11.
I certify that I have read this application and state th4buildinc
,
work for which this permit is issued (Sec. 3097, Civ. C.).
-
city and county ordinances and state laws relating toion, reby authorize representativesofhis
county to enter upon the above-mentioned pron oses.Lender's
Name:.Date:
.Signature (Applicant or Agent):
Lender's Address:
'
LQPERMIT
Application Number
12-.00000342
Structure Information
Construction Type
TYPE V, UNPROTECTED
Occupancy Type
DWELLG/LODGING/CONG <=10
Other struct info
CODE EDITION
2010 CBC
------------------------------------------------------------------------
# BEDROOMS
.•00 .
Permit
BUILDING"PERMIT INV FEE
Additional desc
Permit Fee . . .
180.00 Plan Check Fee
58.50
Issue Date
Valuation.
7000
Expiration Date
10/09/12
Qty Unit Charge
Per
Extension-.
BASE FEE
90-.-00
5.00 18.0000
THOU BLDG 2,001-25,000
90.00
Permit . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee
24:75 Plan Check Fee
,6.19
Issue Date
Valuation
0
Expiration Date
10/09/12
.Qty Unit Charge
Per
Extension
BASE FEE
15.00
13.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20'•
9.75
Permit 'PLUMBING
Additional desc .
Permit Fee.
27.00 Plan Check_ Fee
6.75
Issue Date
Valuation
0
Expiration Date
10/09/12'
Qty Unit Charge
Per
Extension
„
BASE FEE
15.00 .
2.00 6.0000
EA- PLB FIXTURE
12.00'
----------------------------------------------------------------------------
Special Notes and Comments
REMODEL TO EXISTING RESIDENCE.
DEMOLITION TO EXISTING WALL SEPARATING
LIVING ARE FROM KITCHEN, DINING AND
ENTRY'. NEW CABINETRY,
RELOCATE
APPLIANCES, KITCHEN..LIGHTING
AND GFI
RECEPTACLES. PROPERTY.WAS
CITED PER CRC
R108.6 Work commencing before permit..
Application Number: 12-00000342
------ ---
Special Notes. and Comments '
issuance. Any person who commences any.
—work requiring a permit on a building,
structure, electrical, gas, mechanical
or,plumbing system before obtaining the
necessary permits shall be subject to a
fee established by the applicable
governing authority that shall.be in
addition to -the required permit fees.
2010 CODES.
-----------------.-_------------------------------------ -- --
Other Fees BLDG STDS.ADMIN (SB1473)
- - - - - --
1.00
ENERGY REVIEW FEE
5.85
Fee summary. Charged Paid _
Credited
Due
Permit Fee Total 231.75 .00
.00"
231.75
Plan Check.Total 71:44 .00
.00
71.44
Other Fee Total 6.85 .00
.00
6.85
Grand Total 310.04 .00
.00
310.04'
LQPERMIT - - - -- -
-
in.
Of Qutntd
`building St. Safety Division .
Box 1504,78-495 Calle Tampico..
La .Quinta, CA 92253 - (760) 777-7012
Building Permit Application' and Tracking Sheet
mail
Permit#P.O.
. 3 A T
ProjectAddress:.Gj 3- '7Q �ll' U r� ' �'
•Owner'sName:. SIC' e �C
A. P. Number .
Address:
Legal Description:.
City, ST, Zip:
Contractor. j �-k Yl/5 / �f
Telephone: `3ss`1 • "
Address: �S 70 a S
Project Description:
City, ST, Zip: Q► C C ' �'/�
�j'j cV(l C.�t ICE / [
C 0—
Telephone:% 6oZra 7o Sr( „a : ,z��; ,•
r <;
A bA -,' 0 IJC I.I
State Lic. # : 7SoO6 j,. 'City Lic #;
Arch., Engr.; Designers �—C l M Yeti 0CP
�Mc e?4 S.l i•� L• D��
DQ ' J
Address: P10 bbr (O ?Z
City., ST. Zip: D 7 S q22 �0
Telephone - ' ~ '
•Z� 7-7.5 / g%� � � ; ,
State Lic #:
Name of Contact Person:4)uC /1 �SO../
VJA I -L A 1,• AAh
Construction Type:. Occup cy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:
# Stories: # Units:
Telephone # of Contact Person: O Z7 2 70 IrY
Estimated Value of Project '7 o o o •
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
3
Pian Check submitted.
(
it. Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit. .
Truss C21a•
Called Contact Person
Plan Check Balance
Title 24 Calci.
Plans picked up
Construction
Flood plain plan
Pians resubmitted.'.
Mechanical
Grading plan
2'' Review, ready for corrccGo rssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review; ready for corrections/issue
Developer Impact Fee
Planning Approval.
Called Contact Person
AXP.P:
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees