BRES2016-0137VOICE (760) 777-7125
78-495 CALLE TAMPICO C 0 4#Z4P
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LA QUINTA, CALIFORNIA 92253 I FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date:5/26/2017.
Application Number: BRES2016-0137 Owner:
Property Address: 54027 SOUTHERN HILLS ROBERDES CHANG A
APN: 77510103454027 SOUTHERN HILLS
Application Description: CHANG ROBERDES / REMODE OV„E 0 '62 � ® LA QUINTA, CA 92253
Property Zoning: �-- _��
Application Valuation: $87,505.60
Applicant: MAY 2 6 2017 U. Contractor:
R & D ENGINEERING CONT R & D ENGINEERING CONT
54015 SOUTHERN HILLS • CITY OFLA QUINTA 54015 SOUTHERN HILLS
LA QUINTA, CA 92253 DESIGN AND DEVELOPMENT DEPARTMENT LA QUINTA, CA 92253
(760)238-1510”
Llc. No.: 280733
---------------------------- ----------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that lam licensed 'under provisions of Chapter
9,(commencing with Section 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
,License Class: A. B, C33, D24 License No.: 280733
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)::
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 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.):
(_) 1, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (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 contracts for the projects with a contractor(s).licensed pu�ant to
the Contractors' State License Law.).
(_) I am exempt under Sec. B. . . fo this reason
Date: Owner:
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 Address:
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 insurance, as required by
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:
Carri EXEMPTPolity Number:
I Certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if I should become subject to the
Workers' compensation provisions of Sectio 0 f the Lab ,' I hall f
comply with those provisions. I/
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND 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 Building Official fora 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 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 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 is co
I agree to comply with all city and county ordinances and staTa-v),sgelatin bit i
construction, and hereby authorize representatives of this ty to re up n tt �
above-mentioned property for inspection purposes.
Date: d , Signature (Applicant or Agent
FINANCIAL
DESCRIPTION ACCOUNT
QTY
AMOUNT
ADDITION, EA ADDITIONAL 500 SF
101-0000-42400'
0
$124.72
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ADDITION, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$34.80
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ADDITION, FIRST 100 SF
101-0000-42400
0
$120.83
DESCRIPTION
ACCOUNT
QTY
AMOUNT .
ADDITION, FIRST 100 SF PC
101-0000-42600
0
$171.14
Total Paid for ADDITION: $451.49
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - YES ADMINISTRATIVE STAFF
101-0000-42600
0.25
$10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER
101-0000-42600
2.5
$237.50 .
Total Paid for BLDG CITY STAFF - PER HOUR: ,. $247.50
DESCRIPTION'
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$4.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $4.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIALJA ADDITION 1,000SF
101-0000-42403
0
$12.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, EA ADDITION 1,000SF, PC
101-0000-42600
0
$5.08
DESCRIPTION
'ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$145.03.
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$47.86
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $210.30
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402
0
$108.78
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$72.51
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FURNACE
101-0000-42402
0
$108.78
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FURNACE PC
101-0000-42600
0
$72.51
Total Paid for MECHANICAL: $362.58
DESCRIPTION
ACCOUNT
QTY
AMOUNT.
SMI - RESIDENTIAL
101-0000-20308
0
$11.38
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $11.38
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
S02-0000-43611
0
s ... ; Total'Paid for TECHNOLOGY ENHANCEMENT FEE: i .$5.00
DESCRIPTION •
ACCOUNT
QTY,
AMOUNT '
" DOOR/WINDOW, REPLACE FIRST 7
101-0000-42400
G'
$60.91
` DESCRIPTION
ACCOUNT .,
QTY
AMOUNT
DOOR/WINDOW, REPLACE; FIRST 7 PC
101-0000-42600
0
$110.22