12-0470 (RER)-
P.O. BOX 1504
78-495 CALLE TAMPICO .
LA QUINTA; CALIFORNIA 92253
Application Number: C 12-60000470
Property Address:_ - --'52910-AVENIDA`VALLEJO
APN: 773=324-008-19 -000000-
Application description: REMODEL - RESIDENTIAL
Property Zoning:. COVE RESIDENTIAL
Application valuation: 3000
Applicant:
T4ht 4 XP Q"
Architect or Engineer:
ala
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that.) 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:
B Da/%L' No.: 624823
te:/JL//Z ontractor: /
OWNER -BUILDER ION
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 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
pursuant to the Contractors' State Licensa Law.).
I—) I am exempt under Sec. , B.&P.C. for 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:
LQPERMIT
Owner:
HIGGINS GEORGE D
Contractor:
BAILEY CONSTRUCTIO
18340 YORBA LINDA
YORBA LINDA, CA 92
(714)719-0000
Lic. No.: 624823
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/30/12
' 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:
Carrier CA INS Policy Number 468288220102
_ 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 Section
3700 of the Labor_590. hall forthw' ply with those provisions.
Daet:�307 APPIi,
WARNING: FAILURE TO CURE WORKERS' MPEN N COVE AGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES 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 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 correct. 1 agree to comply with all
city and county ordinances and state laws relating to building constructs n reby authorize representatives
of this county to enter upon the above-mentioned pro inspe on ses.' ,
Date S' -tura (Applicant or A ntl:
LQPERMIT
Application Number .
. . . . 12-00000470
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . .
•54.00 Plan Check'Fee
35.10
Issue Date
Valuation
3000
Expiration -Date
10/27/12
Qty Unit Charge
Per
Extension
BASE FEE
45.00
1.00 9.0000
THOU BLDG 2,001-25,000
9.00
----------------.------ --
Special• Notes and Comments
--
FIRE REPAIR: REMOVE
& REPLACE DRYWALL
TYPEX 5/8" IN GARAGE.
2010 CODES.
----------------------------------------------------------------------------
Other Fees . . . ...
. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
3.51
Fee summary Charged Paid Credited
Due
Permit Fee Total
54.00 .00 .00
54.00
Plan Check'Total
35.10 .00 .00
35.10
Other Fee Total
4.51 .00 .00
4.51
Grand Total
93:61 :00 .00
93.61
LQPERMIT
Bin.#
Pemtlt #
Project Address:9/(�
oty. Of La Quinta
Budding 8L Safety Division
P.O. Box 1504,78-495 Calle Tampico
14.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Vf� U/Q.'� Owner'sName:.� ;
A P. Number.
Address:
Legal Description:
Contactor. %i�b� �G C'OJ.Is�iL(JG�i Dal
City, ST, zip -.
Telephone: s3 `
Address: R !�
i 0.4C a7
Project Description:
City, ST, Zip: - •d /L/J;1 b %J17� C M l l.�i 6
7tY/ 77. 9qK .1
Telephone
State Lie. #: 2 Y Y.Z I City Lie. #.:
I( -b u+i. ��-� �►� U/10 Ae X i
Arch., Engr., Designer
Address:
City, ST, Zip:
Telephone: y :a
State Lie. #: i aiu -
Name of Contact Person: PAT TA l p
Construction Type:. JWA46Dc/ Occupancy:
Project type (circle one): New Add'n Alter Repair o'
Sq. FL: # Stories: J
#Univ
Telephone # of Contact Person:
Estimated Value of Project 13LI 0Q
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
.'Rec'd
TRACIMG
PERMIT FEES.
Plan Sets
Plan Check submitted
item
Amount
Structural Calces
Reviewed, ready for corrections
Plan Check Deposit. .
Truss Cafes.
Called Contact Person
Plan Check Balance.
Title 24 Calci.
Plans picked up
Construction
Flood plain plan
Plans resubmitted, .
Mechanical
Grading plan
rl Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SALL
H.O.A. Approval
Plans resubmitted
Grading -
IN HOUSE:-
'"' Review, ready for cormcdonsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees