14-0583 (SPIN)R -k
T
P.O. BOX •1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO ,; ` FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 .� BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT_-
- ., _ � . _ - - - -� •� _° : -' _ -- i.+ - _ - - . - - - - - .� ' : - .. .: _ Date~ 5/13/14
Application Number: 14-00000583 Owner:.-•
Property Address: 78302 TALKING ROCK TURN LYON DONNA M REV. TRUST
APN: 770-290-014' - - 1406.N. ASTOR STREET o ;
Application description: SPECIAL= INSPECTION CHICAGO, IL 60610 }
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 82700./A
Contractor: l
Applicant: - Architect or Engineer: PIERCE CORPORATION, ANDREW IUD" �} G
P.O. 'BOX '3420` i " _ a. - • . .,
` PALM DESERT, CA 92261-3420
(760) 346-3228 _C "()FUWTA
Lic. No.. 671203 Q44NiEnEp
---------------------------------------------------.------------------------------------------.----- -
` - - • 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 aqO.Prqfessionals Code, andLicense is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided -
License Clas • B is 6 1203 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is _
_ issued. `
Date Contractor- _ I have and will maintain workers' compensation insurance, as required by.Seaion 3700 of the Labor
Code, for the performance of the work for which this permit is issued. My workers' compensation
XO NER-BUILDER DECLARATION - insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I a exempt from the Contractor's State License Law for the Carrier STATE FUND -Policy Number 00041509189
• . 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) or 3.700 of the Labor Code o hwitco visions. `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 huntlred dollars ($500).: Date �pplicant - —�`�%se
_
1 _ 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' OMPENSATION 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 PE ALTIES AND CIVIUFINES 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::- M _ :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{rSot build or -
improve for the purpose of sale.). r 3 APPLICANT ACKNOWLEDGEMENT -
_r (=) 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 contractors) 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._ , BAP.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
f 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. -
Date: Owner: - 2. Any permit issued as a result of this application becomes null and void if work is not commenced
Y
- - - - within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject
CONSTRUCTION LENDING AGENCY permit to cancellation. -
7 =_ — I hereby affirm under penalty of perjury that there is a construction lendingg-agency for the performance of the - ' - I certify that I have read this application and state that the above information is correct. I agree to comply with all '
work for which this permit is issued (Sec. 3097, Civ. C.).' - • city and county ordinances and state laws relating to building co tion, and hereb au representatives
of this cou to ter= pon the above-mentioned property p pose
Lender's Name:
Dat-} i ure (Applicant or Agent): __ �r = —'+_•- -�••
- Lender's Address: - s
LQPERMIT
Application Number �� ~. 14-00000583
Permit . . . SPECIAL INSPECTION
Additional desc .
Permit Fee; - 250.25 Plan Check Fee
-00
' Issue Date . . . . Valuation
•82700
Expiration Date 11/05/14
' Qty Unit Charge Per
Extension
_ 1.00 71.5000 EA MISC SPECIAL INSPECTION
71.50
1.00 178.7500 EA MISC SPECIAL INSPECTION, PC
178.75
.00 143.0000 HR HOURLY CHARGE, CITY STAFF
. .----------------------------------------------------------------------------
.00
Special Notes and Comments
CHANGE OF CONTRACTOR. ALL DURRETT CONST.
WAS THE CONTRACTOR OF RECORD UP TO
DRYWALL -AND EXT. LATH, INSPECTED ON
10/22/2012. PERMIT #10-216 HAS EXPIRED A
NEW PERMIT #14-583 IS BEING ISSUED TO
ANDREW PIERCE FOR COMPLETION OF.REMODEL
/ ADDITION. ANDREW PIERCE WILL BE
COMPLETING TILEWORK, PLUMBING TRIM,
DRYWALL PATCHING,.MIRRORWORK, MINOR
ELECTRICAL AND PAINTING.
May 6, 2014 9:29:14 AM jjohnson.
Fee summary Charged Paid Credited
-----------------
Due
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Permit Fee Total 250.25 .00 .00
250.25
Plan Check Total 00 .00 .00
.00
Grand Total 250.25 .00 .00
250.25
LQPERMIT