13-1284 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00001284
Property Address: 57464 INTERLACHEN
APN:, 762-180-020- - -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6500
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
CARY FALK
Contractor: D
Applicant: Architect or Engineer: 7C r S CONSTRUCTION & MAINT
48236 VISTA DE NOPAL
LA QUINTA, CA 92253
C00-� r�o,�
(760)564-5811o.:594
l" l�l. '�/ IBJ Lic. No.: 594043
' LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury th licensed under provisions of Chapter 9 (commencing with
Section 70001 of Division 3 of the Busine s an Profession Is Code, and my License is in full force and effect.
License Class: B license No.: 594043
Date) k -I �,-I Contractor:
WN -BUILDER DECLARATION
I hereby affirm under penalty of perjurylet I a ex pt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Pro sions 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).:
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
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 I, 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 License Law.).
(_ ) 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.1.
-Lender's Name: _
.Lender's Address:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/25/13
°D
NOV 12 2013
IOU
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 polic er are:
Carrier STATE FUND _ P icy Number 713-2611-2011
I certify that, in the perfo ante of th work for which this permit is issued, I shall not employ any
person in any mann e so as to beco a subject to the workers' compensation laws of California,
and agree that, if Is ould becom subject he workers' compensation provisions of Section
- 3700 of the Labor forthwit comply with those provisions.
Date) 1- 7� 1 3 Applicant: - -
WARNING: FAILURE TO SECURE RKERS' CPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMI NA
L PEL IES 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 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 per . r cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the ove infor ation is correct. I agree to comply with all
city and county ordinances and state laws relating to buildi g constru ion, and by authorize representatives'
of this county to enter upon the above-mentioned property for ction purp ses.
Date: _1ignatuie (Applicant or Agent):
Application Number . . . . . 13-00001284
Permit . . .
ELECTRICAL 2013
Additional desc .
Permit Fee . . . .
23.83 Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date
4/23/14
Qty Unit Charge
Per
Extension
1.00 23.8300
- ----------------------------------------------=-----------------------------
LS ELEC FIXTURES, FIRST 20
23.83
Permit . . . MECHANICAL 2013
Additional desc . .
Permit Fee . . . .
23.84 Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
4/23/14
Qty Unit Charge
Per
Extension
1.00 11.9200
EA MECH APPL REP/ALT
11.92
1.00 11.9200
----------------------------------7-----------------------------------------
EA MECH VENT FAN
11.92
Permit . . . PLUMBING 2013
Additional desc .
Permit Fee . . . .
35.76 Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
4/23/14
Qty Unit Charge
Per
Extension
2.00 11.9200
EA PLBG•FIXTURE/TRAP
23.84
1.00 11.9200
EA PLBG WATER INST/ALT/REP
11.92
7 ----------------------------------------------------------------------------
Permit . . REMODEL 2013
Additional desc . .
Permit Fee . . . .
48.62 Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date
4/23/14
Qty Unit Charge
Per
Extension
1.00 48.6200
LS MISC REMODEL, 1ST 100 SF
:
48.62
----------------------------------
Notes and Comments
convert existing bath
into powder bath
and new bath.
October 25, 2013.8:43:18
AM jjohnson.
----------------------------------------------------------------------------
Other Fees . . . .
. . . . BLDG STDS ADMIN (SB1473)
1.00
LQPERM IT
s
Application Number
. . . . .
13-00001284
---------- ------------------------------------------------------------------
Other Fees . . .
. . . . .
PLAN CHECK,
ELECTRICAL
23.83
PLAN CHECK,
REMODEL
132.99
PLAN CHECK,
MECHANICAL
9.54
PLAN CHECK,
PLUMBING
35.76
STRONG MOTION (SMI) - RES
.65
Fee summary
Charged
----------
Paid
----------
Credited
----------------_---
Due
---------=-------
Permit Fee Total
132.05
.00
.00
132.05
Plan Check Total
.00
.00
.00
.00
Other Fee Total
203.77
.00
.00
203.77
Grand Total
335.82
.00
.00
335.82
LQPERN] IT
' I Pub. Wks. Appr I I I Date of permit issue , • I I I I
ISchool Fees 1
-� k(t6wt
Total Permit Fees
Bin #
Qty of La Qunita
Building &r Safety'Division 0 C T 01 2013
Permit.# __ _ ... __
P.O. Box 1504, 78-495 Calle Tampico
— --(a CI-- OC-�_QUINTA--
_. _ _ ___._._ _
Quina; CA -92253. (760).777-7012 ------
_ • -- _ _ _ --. Tt`�DEVELOPME .T
Application �'iii�ey
Building Permit and Trackili
Project Address: 5:7-444-1JQ —it�RLAG#81s/ Owner's Name: IAL/ --
A. P. Number:
QAddress:
Legal Description: ' - —9 Z,% City, ST, Zip: (A (,1(JT A t✓A ,
Contractor: C,
Telephone:
Address:
Project Description: )^ 1 ('C—
City, ST, Zip:
Telephone:
>>':`•�;�:">:is<;:.... :,..:,:::::;;;;;:: /� I c�Y�
State Lic. # :
City Lie. N.-
:Arch.,
Arch.,Engr., Designer: Lg A G 5 t �, . S L
U D► O r I� 3 e,
Address: Po.
City., ST, Zip: LjQ L) l
C7�
Telephone.q(r->cD. S 7L-3. to 7l-7-
;;;.;: ?,
4;<;<•<' "`"`">' " ' ""''"r"`~ '^'
' :i''i
Construction Type: Occupancy:
proect a circle one): New Addn Alter Re
j type ' air Demo
) P
State Lic. #:
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person: �q� 5 �� %O �—
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACMG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Cluck Deposit
Truss Cala.
Called Contact Person
Plan Check Balance,
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correcli ssue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''d Review, ready for correctionsrissue
Developer Impact Fee
' I Pub. Wks. Appr I I I Date of permit issue , • I I I I
ISchool Fees 1
-� k(t6wt
Total Permit Fees