13-0665 (RER) (2)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4.�GV ED VOICE.(760) 777-7012
SC� FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT . INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/23/13
Application Number: 13-000'0066S Owner:
Property Address: 77450 CALLE TECATE EDWIN BURGOS
APN: 774-293-025-12 -000000- 1603 2ND STREET
Application description: REMODEL - RESIDENTIAL MANHATTAN BEACH, CA 90266
Property Zoning: COVE RESIDENTIAL Other struct info C
Application valuation: 150000
Contractor: D A
Applicant: Architect or Engineer: Owner OCT
DITION 20 0
ur FINANCE 0617:
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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: r 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 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).:
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.).
�L� 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
l/ 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.).
1 ) I am exempt under Sec. B.&P.C. for this mason
Date: I b S 3 Owner:
�.—
I hereby affirm under penalty of perjury that there is mon
work for which this permit is issued (Sec. 3097, Civ. C.1.
Lender's Name: (�
Lender's Address: \
LQPERMIT
LENDING AGENCY
)n lending agency for the performance of the
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 in�rance, as required by Section 3700 of the Labor
Code, for the performance of the/subct
h' h this permit is issued. My workers' compensation
nsurance carrier and policy num
Carrier ------------------ er
I certify that, in the performance of r which this permit is issued, I shall not employ any
person in any manner so as to bect to the workers' compensation laws of California,
• and agree that, if I should mo the workers' compensation provisions of Section
"37;of the Labor Cod , I s II fmply with those provisions.
Date:Applicant:�
Y�
WARNING: FAILURE TO. SECURE WORKERYALI
OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PEIESAND 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 Quima, 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 i orrect. I agree to comply with all
city and county ordinances and state laws relating to building construction, a hereby authorize representatives
of this county to enter upon the above-mentioned property for ' p ction p poses.
fr
Date: L 2 ( Signature (Applicant or Agent):
LQPERMIT .
Application Number
13-0.0000665
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 f
BASE FEE
431.86
} 125.00 .8100
THOU BLDG $25,001-$200,000
101.25
Permit ELECTRICAL"2.013
- 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 . . .
1 .Valuation
4/21/14
. . .
. 0
Expiration Date
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
119.20
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
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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.
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Other Fees . . . . . . . . . BLDG-STDS, ADMIN (SB1473)
6.00
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
r
LQPERMIT - _