BRES2016-031678-495 CALLE TAMPICO U -` Qs
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BRES2016-0316
Property Address: 55478 SOUTHERN HILLS
APN: 775190019
Application Description: MILLAR RESIDENCE /BATH REMODELS
Property Zoning:
Application Valuation: $2,500.00
Applicant:
SMITH & SONS CONSTRUCTION INC. ,
9416 WILSON RANCH ROAD
PHELAN, CA 92371
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
OR 92253 v
Date: 11/7/2016
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Owner: cn
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RICHARD MILLAR
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Contractor: m fJ
SMITH & SONS CONSTfCJVN
12626 NW LORRAINE QJ
9416 WILSON RANCH IIDA�
OR 92253 v
I hereby affirm under penalty of perjury one of the following declarations:
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License Class: _ License No.: 810322
Contractor: m fJ
SMITH & SONS CONSTfCJVN
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9416 WILSON RANCH IIDA�
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PHELAN, CA 92371 T
(909)885-2220
Llc. No.: 810322Ei
LICENSED CONTRACTOR'S DECLARATION I WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
I have and will maintain a certificate of consent to self -insure for workers' -
and my License is in full force and effect.
compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: _ License No.: 810322
of t k for which this permit is issued:
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i I have and will maintain workers' compensation insurance, as required by
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Date:' 1 l Contract: �
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:
OWNER -BUILDER DEC RATION
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9039656
1 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
I certify that in the performance of the work for which this permit is issued, I
city or county that requires a permit to construct, alter, improve, demolish, or repair
shall not employ any person in any manner so as to become subject to the workers'
any structure, prior to its issuance, also requires the applicant for the permit to file a
compensation laws of California, and agree that, if I should become subject to the
signed statement that he or she is licensed pursuant to the provisions of the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
comply with those provisions. -
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
Date: T' r� Applicant:
permit subjects the applicant to a civil peAalty of not more than five hundred dollars
($500).:
WARNING: FAILURE TO SECURE WORKERS' COMP SATION COVERAGE IS UNLAWFUL,
(_) I, as owner,of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
he or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
(� I, as owner of the property, am exclusively contracting with licensed contractors
1. Each person upon whose behalf this application is made, each person at•whose
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
request and for whose benefit work is performed under or pursuant to any permit
State License Law does not apply to an owner of property who builds or improves
issued as a result of this application , the owner, and the applicant, each agrees to, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
the Contractors' State License Law.).
employees for any act or omission related to the work being performed under or
( I I am exempt under Sec. B.&P.C. for this reason
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
Date: Owner:
work for 180 days will subject permit to cancellation.
t 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
I 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 cityenter upon the
above-mentioneedd property for inspection purposes. ` I
Date: �, T 1 �° Signature (Applicant or Agen
r Date: 11/7/2016
r
Application Number: BRES2016-0316 Owner:
Property Address: 55478 SOUTHERN HILLS RICHARD MILLAR
APN: 775190019 12626 NW.LORRAINE DRQ
Application Description: MILLAR RESIDENCE /'BATH REMODELS PORTLAND, OR 92253
Property Zoning:
Application Valuation: $2,500.00
Applicant: Contractor:
SMITH & SONS CONSTRUCTION INC. SMITH & SONS CONSTRUCTION INC.
9416 WILSON RANCH ROAD 9416 WILSON RANCH ROAD `
PHELAN, CA 92371 - PHELAN, CA 92371 _
(909)885-2220
Llc. No.: 810322
Detail: REMODEL (2) BATHROOMS. ADD (3) WALL MOUNT LIGHT FIXTURES, (2) LIGHT SWITCHES,.(1) EXHAUST FAN AND REMODEL (2) SHOWERS. THIS
PERMIT DOES NOT INCLUDE THE ALTERATION/REPLACEMENT OF TOLIETS OR SINKS OR ANY REMODEL WORK AT KITCHEN. ALL CONSTRUCTION MUST
COMPLY WITH THE 2013 CALIFORNIA BUILDINGCODES. -
4.
M, •
r 'FINANCIAL INFORMATION
DESCRIPTION
• •
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20'
101-0000-42403 F .
• 0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
VENT FAN
101-0000-42402
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
VENT FAN PC
101-0000-42600
0
$5.07
Total Paid for MECHANICAL: $17.74
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$25.34
DESCRIPTION
;ACCOUNT
'QTY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$25.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTYc
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12:67
Total Paid for PLUMBING FEES: $76.02
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0_.
$0.50
Total Paid for STRONG MOTION INSTRUMENTATION SMI: • $0.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS:
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Permit #
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Project Address: 5
City of Li Q uin td
Buitding 8i Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760),777-701,2
Building Permit Application and Tracking Sheet
Owner's Name: `
A. P. Number:
Address:�/✓�
Legal Description:
City, ST, Zip:
ontrar
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Telephone:
Address:
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Project Description:
City, ST; Zip:
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Telephone:
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State Lie.# : ��.
City Lic: #•: �
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Arch.,'Engr., Designer:
Address:
ip:
• City, ST, Zip-
Tel h
Telephone:
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Con traction T e: Occupancy:
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Lie. #,.
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' New Add'n Alter Repair.
Demo
Project e (circle one
Name of Contact Person:
Sq. Ft.:
# Stories: # Units:
Telephone # of Contact Person:
062
Estimated Value of Project: 5 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Caics.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person .
Plan Check Balance,
Title 24 Calcs.
ti
Plans picked up
Construction
Floodplain plan
Plans resubmitted
Mechanical
Grading"plan
2" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.-
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE,:-
Jr° 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