13-0665 (RER)P:O. BOX 1504 4
r
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY. DEPARTMENT
BUILDING PERMIT
Application Number: 13-00000665
Property Address: 77450 CALLE TECATE
APN: 774-293-025-12 -000000-
Application description: REMODEL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL -
Application valuation: 150000
Applicant: Architect or Engineer:'
1 V
--------------------------------------------------
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 Professionals Code, and my License is in full force and effect.,
License Class: License No.:
Date:. . 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 o1 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 live hundred dollars ($600).:
as owner of the property, or my employees with wages as their sole'componsadon, will do the work, and
! %o the structure is not intended or offered for sale ISec. 7044, Business and Profossiuns 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
ono your of complation, the owner -builder will have the burden of proving that he or she did not build or
unprovo for the purpose of sale.).
u1eoa?. owner of, the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Bus(nyss 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
npursuant to the Contractors' State License Law.)..
am exempt under Sec. , B.&Por this rdnson
A.,- I CONSWUCTION LENDING AGENCY
1 hereby affirm under penalty of perjury that there Is Pgonstruction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ, C.I.
Lender's Name:
Lender's Address:
LQPERMIT
Owner:
EDWIN BURGOS
1603 2ND STREET
MANHATTAN BEACH, CA 90266
Other struict info .
•,
Contractor:
Owner
DITION 20
VOICE (760) 777-7012
r FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/23/13
C -
------------------
WORKER S COMPENSATION DECLARATION
1 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 ii,.,tce, as required by Section 3700 of the Labor
Code, for the performance of the work for wh 'lFthis permit is issued. My workers' compensation
�person
�anymanner
Eas
mber are:
Carrier_ ---Policy Nmr or
�jofthe work on'wliich this permit is issued, I shell not employ any
become s joct to the workers' compensation laws of California,
and agree that, if I should. mesub' of to the workers' compensation provisions of Section
37 .0 ol. the L_a..ho�r "Cods 11•f 1 Ith comply with those provisions.
Date:' � �• � '�jAppll,���" •
WARNING: FAILURE TO SECURE WORKER OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PE ALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 16100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 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 sot 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'daya from date of issuance of.such permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that 1 have read this application and state that the abovt�ion
mation I drreeI. I agree to comply with all
city and county ordinances and state laws relating to building cction, -a hereby authorize representatives
01 It Js Our
t�'(b1 I tier upon the above-rnendorietl proper o� ri poses.
Oa y��Ar�l/�/.SignOturO (Applicant or Agangt
0
Application'Number
13-00000665
s
Permit BUILDING 2013
Additional desc .. ..
Permit Fee . . . .
533.11 Plan Check
Fee
.00
Issue Date
Valuation
150000
" Expiration Date
4/21/14
Qty Unit Charge
-'Per <
Extension
BASE FEE
431.86
125.00 .8100
THOU BLDG $25,001-$200,000
101.25
Permit
ELECTRICAL 2013
Additional desc .
Permit Fee
23.83 Plan Check
Fee
.00
Issue Date
Valuation
0
Expiration Date
4/21/14
Qty Unit Charge
Per
Extension
1.00 23.8300
LS ELEC FIXTURES, FIRST 20
--------------
23.83
Permit
MECHANICAL 2013
Additional desc.
Permit Fee
35.76 Plan Check
Fee
.00
Issue Date
Valuation
0
Expiration Date
4/21/14
Qty Unit Charge
Per.
Extension
1.00 11.9200
.EA MECH APPL.REP/ALT
11.92
1.00 11.9200
EA MECH VENT FAN
11.92
1°"00 11.9200
EA MECH EXHAUST HOOD
11.92
Permit
PATIO COVER 2013
Additional desc .. .
•Permit Fee
131.56 Plan Check
Fee
.00
Issue Date
Valuation
150000
Expiration Date ••
4/21/"14 "
Qty Unit Charge
Per
Extension
1.00 131.5600
EA MISC PATIO COVER, SPEC
131.56
Permit
PLUMBING 2013
Additional desc .: ..
Permit Fee
286.08 Plan Check
Fee
.00
Issue.Date
Valuation
.0 "
LQPERMIT
-
Application Number 13-00000665
Permit . . . PLUMBING 2013
-
Expiration Date 4/21/14 •
Qty Unit Charge Per
Extension
11.00 11.9200 EA PLBG FIXTURE/TRAP
131.12
10.00 11.9200 EA PLBG ROOF DRAIN
11920
1.00 11.9200 EA PLBG WATER HEATER/VENT
11.92
1.00 11.9200 EA PLBG WATER INST/ALT/REP
11.92
1.00 11.9200 LS -PLBG GAS SYS, 1-4.OUTLETS
11.92
----------- _-------------------_--:--_----- --.._
Special. Notes and Comments
REMODEL, CONVERT EXISTING GARAGE TO
LIVING.SPACE 450 SQ. FT. 806 SQ. FT.
PATIO -ADDITION, NEW GARAGE OF 456 SQ.
FT. WITH 144 SQ, FT. LIVING SPACE
ADDITION. 368 SQ. FT. DECK AND NEW FIRE
SPRINKLERS @ 3731 SQ. FT. PER 2010 CALIF
BUILDING CODES.
August 5, 2013 12:49:33 PM JJOHNSON.
Other Fees . . BLDG STDS ADMIN (SB1473)
6.o6 -
PLAN -CHECK, ELECTRICAL
23.83 _
PLAN CHECK, REMODEL
253.11•
PLAN CHECK, MECHANICAL
19.08
" PLAN CHECK'; PLUMBING
293.22
. _ STRONG MOTION (SMI) - RES
15-.00
Fee summary.' Charged Paid Credited
Due
----------->---.--- - -------- - - - - - - - - --_ ----------
Permit Fee Total 1010:34 .00 .00
1010.34
Plan Check Total .00 .00 .00
.00
Other Fee Total 610.24 .00 .00
610.24.
Grand Total 1620.58 .00 .00
1620.58
LQPERMIT
It _
_... _ (�
City of. La QuInta
Permit #' P.O. Box f504,78-495 Caffe Tamptco
4 QAta, CA 92253 -:(760) 7774012
it 4 -
Building Pennit -AWfcatlon'and Trackinje Sheet
-
Pwj=t:Add"--/7-qbD C)WE
Ovmees Nme,. W A) 90-P-(705
A. P. Number. :7 0 0 Z s
Address: 1 3 Z IVD SIF -
Legal Description:
CDntractqr. 0 '/\m) F 0
City, ST. Zip:
Telephone:
Address'
E!rOJCr tion: -,dPOSE70 Fr-fAhVljn�-)
4D=ip pf /,0 A/
City. . $T, Zip.
—INCUOIA47 �- NFVNJ
Telephone:
State Lic,latyu,&-
1�
Am(L, Eag., DMguerL/ & \,Jf-�j CO Aj- Trj
Address , Io
Clty.ST,�P: 14 6VIA/ c--4
Telephono0o� 56- 4 - q-'70 Cautmcdon T�pt.
0 'M
StatcLia #.- Project
-C7 -14
Name ofConWPerson .- Sq. Ft I"'
Tetepiwac # of Contact Pelson: (710 �6 I -f 1470 7 �value offlmjcct
i'n Alta air Demo
#Utdt;:
9 Submittal
plan sea
Rtqd
'-Rec'd
TRAXMG
Plan Check submitted . . . . . . . . .
.ItemAmotmt
PERMYFM-
r
-stmet" cjac&
RevicW4 Mdtr for corirecdow
rim chcckDqmIt,
TYross Calks.
Called CmituA Pusan
V
Plan Check Balance.
LTIde 24 Calci.
Plans plekid up
0
CMtrtd,u
Flow plain plan
Plans raubrilftV.
k �s
mmmfik�
Grading plan
T� Review. ready rco �04
Electrical�
Subcontactor LAA
Great Deed--
called contact P
Plans picked up
PtumbC�ml
S&MJILL
C- I OQ-5
i tki) , FO qnOA,)
ILOA., Approval
Plans resabraitted
Vl�
C-raing6�,,b
P&PA IP
IN YZE0 USIL.
Planning Approval.
3" Review; ready for awrectionvissue
Called Contact Person
Dcv*elo
Impact Fee
ip. 1- 4-11 CAj
Pub. Wks.'Appr
Date of perwit!"t
wl (ifqtm
Oca-t uro A—
School Fees
Total P
Fees
*1NSD(,jai
1'05 AAPRO
b
.4
Date
9/30/13
No.
31826
Owner
Burgos
Address
77450 Calle Tecate .
City
La Quinta Zip 92253
Tract # -
-
Type
Residential Addition
Lot # No. Street
Unit 1 77450 Calle Tecate
Unit 2
Unit 3
Unit 4
Unit 5
Comments
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760) 771-8515
S.F.
594
Unit 6
Unit 7
Unit 8
Unit 9
Unit 10
APN #
Jurisdiction
Permit #
No. of Units
Lot # No.
C
Q BERMUDA DUNES r
00 RANCHO MIRAGE b
N INDIAN WELLS
PALM DESERT,
t� LA QUINTA
4INDIO
774-293-025
La Quinta
Street
S.F.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under
500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile
homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
EXEMPTION NOT APPLICABLE
This certifies,that school facility fees imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $3.20 X 594 S.F. or $1,900.80 have been paid for the property listed above and that
building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued.
Fees Paid By C/C Union Bank, Ben Gilmore Check No. 0113017671
Bank Name/Recipient of Certificate Telephone 760/989-0188
Funding Residential
By Dr. Gary Rutherford
Superintendent '
Fee collected lexemd by Patricia Barbuzza Payment Recd
$O.OoT',
.
$1,900.80 .Over/Under
Signature
"KI,
NOTICE: Pursuant to Government Code Section 6 0(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees
or other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
NOTICE: This Document NOT VALID without embossed seal
Embossed Original - Building Department Applicant Copy - Applicant/Receipt Copy - Accounting
r
Twitt a."
P.O. BOX 1504
LA QUINTA, CALIFORNIA 92247-1504 BUILDING & SAFETY DEPARTMENT
78-49.5 CALLS TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
PROPERTY OWNER'S PACKAGE
Disclosures & Forms for Owner-Bui tiers Applying for Construction Permits
_40WORMAT! NOT )CCE TQ PROPERTY OWNER
Dear Property Owner
An, application fora t his been sub ed in your name u'�ting yotuxelf as the builder of the Property
improvements specified ab��:�: � (� ���Q- y t ti G
We are providing you with as Owner -Builder Acknowledgment and Information Verification Form to make you awave of your
responsibilities and possible risk -:you may,mcur by 4ving.thispermit issued in your name as the
Owner -Builder. We will not issue a building pexmit until..you have read, initialed your understanding of eack'provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
unless you, the property owner, obtain the prior approval of the permitting authority.
cr vy"V.4k -a AliAr0J1VYL;"1lyj:ly'1AND'VERIFICATION OF WFOPMA NIN
DIRECHONS: Read and initial each statement below to signify You understand or verify this information.
understand a frequent practice of tinlicensed persons is to have the property owner obtain an "Owner -Builder"
budding permit that erroneously implies that the property owner is providing his or her own labor and material personally. I, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my property. w
My homeoner's insurance may not provide coverage for those
mjunes..l am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers
on my property.
understand building permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
understand as an "Owner-Buildee"I'am the responsible party` of record on the permiL I understand that I may protect
myself from.potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
tugderstand Contractors are required by law to be licensed and bonded,in California and to list their license numbers on
permits and contracts.
Q/understand if I en'iploy o'r otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at: least five hundred dollars ($5;00), including'labor and materials, I may be considered an "employer"
under s'taie and federalYlaw.
understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide woiicets' compensation disability insurance, and contribute. to unemployment
compensation for each "employee. I also understand my failure to abide by these laws may subject me to serious financial
risk.
q4(j7-I`understand under California Contractors' StateLicense Law, an Owner -Builder who builds single-family residential
structures cannot .legally build them with the intent to offer them for sale, unless all work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with a licensed general building Contractor.
understand as an Owner -Builder if 1 sell the property forwhich this permit is issued, I may be he'd liable, for any
financial or personal. 4uries sustained by any subsequent owner(s) that result from any latent construction defects in the
workmanship or materials. ` �41
JL��l understand I may obtain more information regarding my obligations as an "employee' from the h tenml Revenue
ervice, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.
tL�tw_ I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand'that 1 am the
party le ally and financially res while for proposed conslt�uetion activity at the following address:
117 "
I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all
app ble laws and requirements that govern Owner-Btnldersas well as employers.
agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information I
have provided on this form Licensed contractors are regulated by laws designed to protect the public. If you contract with
someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss
you may sustain as a result of a complaint' Yore only remedy against unlicensed Contractors may be in civil court- It is also
important for you tounderstand that if an unlicensed Contractor or cnVloyee'of that individual or firm is injured while wodling
on your property; you may be held fiable for damages. If you obtain a permit as,Owner-Builder and wish to bin Contractors,
you will be responsible for verdy'arg whether or not those Contractors are property licensed and the status of their workers'
compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner aad returned to
the agency responsible for issai>ag. Note:. py of tke propety owner's diriver'sliapnsv� faun no4ia[>7trtr m or
other vert tcation aeceptable a ag r ' ed a be presented when the permit is iastted to ver* the pmperty
owner's signature.
Signature of property owner Date:_10
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understandis my personal responsibility, l hereby authorize
the following persons) to act as my agents) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project.
Scope of Construction Project (or Description of Work): JZEIW004_ � 'EX 5T%t-1(r b1MC
Project Location or Address: �O GaLL..E TC—
Name of Authorized Agent: AGN ALM OQE Tel N441/00-)
Address of Authorized Agent: 5(4q95 AUC -01M M AL.VAa^06 ILAVIO,^ CA 4t225?2
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its neriine of : .Copy e o er's driver's license, form notarization, or other verification
acceptable to the agency is requ' ed to e r d w n the permit is issued to verify the prop rty o en's signature.
CJ
Property Owner's Signature: Date:
' CITY, Of LA
JOB ADDRESS 450 _ CALLC-- TE -C -AVE PERMIT NUMBER
f .
QUINTA-SUB-CONTRACTOR L1 -ST '
OWNER' El '90RkS : BUILDER QtAIJ.EVZ-/ Y3U(L.�IrL.
times in a conspicuous placer Only persons appearing on'this list or their employees are authorized to work
on this job. Any -changes to this list must be approved by the Building Division prior to commencement of work. 'Failure to comply will result in a stoppage of work and/or the voidance
of. building permit. For each applicable trade, all information requested below must be com'Dleted by applicant "n., GiIA_" ie not an accPntahI6 rPcnnncP
Trade Classificat
/ �o Contractor
. . ' ...
State..Contrac
. ....::::..... .....;:
tot sLicense
:..;-; -- � �� ' � � �-
: .
.. .;:' :' • ... Workers GompensaLon'insurance''•. -::, '...::;:�.. : `;.' `
:.. 'City Business Lic�nse�:::•
{ Company Name
Classification
License Number
Ezp. Date
Carrier Name Policy Number
Exp. Date
License Number
Ex Date
p�
le.g. A, B, C-8)
(xxxxxx)
(xz/xx/xx)
(e.g. State Fund, CalComp) (Format Varies)
• (xx/xx/xx)
(xxxx)
(xx/xx/xx)
EARTHWORK (C712)'--'.:. NbIJ�
CONCRETE (C-8)' �T-Z c n1acCETE CO.
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�F �wa�ra
Building & Safety Department
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7012 voice — (760) 777-7011 fax
RECEIVE®
JUN 17 2013
CITY OF LA QUINTA
C0MUIdI7y DEWLOPMENr
To: Greg Butler, Building Official To: PD: May 28, 2013
From: Les Johnson, .Community Development Director Due date: ASAP
Permit #13-665 Status:_1 ST Review
Building Plans Approval
(This is an approval to issue a Building Permit)
.CVMSHCP Applicable Fee N/A.
.The Planning Department has reviewed the Building Plans for the following project:
Description: Remodel of SFD in the Cove
Address or general location: 77450 Calle Tecate APN: 774-293-025
Applicant Contact: Steve ph: 760-564-4707, r
The Planning Department finds that: ,
❑ ...these Building Plans do not require Planning Department approval.
these Building Plans are approved by the Planning Department.
❑ ...these Building Plans require corrections. Please forward a copy of the attached
correctionsto he applicant. When the corrections are made please return them.
to th Plann' g Department for review.
ZME
Les ohns ,Community Development. Director„ 'Date
NOT ' PLE E RETURN PLANS WITH GREEN SHEET TO THE BUILDING AND
SAFET EP RTMENT
0
f
4'
Bin #City
of La Quinta
Building 8t: Safety Division
P.O. Box 1504, 78-495 Calle Tampico
3 La Quinta, CA 92253 - (760) 777-7012
--- Building Permit Application and Tracking Sheet
Permit
Project Address. `-- Q `LC
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
Address:
Project Description:
City, ST, Zip:
IE S 0\J 1) tj P�1lL
Telephone:
State Lic. # :
City Lie. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
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Telephone:
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Construction Type: Occupancy:
State Lic. #: .
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: 1 L_U��
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Perso (o 0 F) ,E�>
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
/1
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cala.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
21" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
R.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'"' Review, ready for correction issuDeveloper
Impact Fee
Planning Approval
Called Contact Person. 1/a°
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
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