13-0662 (RER)P.O. BOX 1504+.`r
78-495 CALLS TAMPICO r
LA QUINTA;,CALI,FORNIA 92253.
Application Number:
Property Address:
APN:.
Application description:
Property Zoning:
Application valuation:
Applicant:
13-00000662
78900 ZENITH WY
�0
a
VOICE (76U) 777-7012
`. t • • ' FAX (760) 777-7011
BUILDING & SAFETY DEPAR-TMENT ,INSPECTIONS (760)_777-7153
BUILDING PERMIT
609-560-023-23 -23773
REMODEL - RESIDENTIAL L/
LOW DENSITY RESIDENTIAL U
5000 . .
t
t
Architect'or Engine C
Owner:
DAVISON DOUGLAS JAMES
LA QUINTA, CA 92253
(760)000-0000
Contractor:
DANIEL'S D K I
73950 DINAH SHORE DRIVE, #302
PALM -DESERT, CA 92211
(760)320-2128
LiC. No.: 581149
Date: 5/24/13
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 Busines nd Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: El -,CSI -C15-12 Licellse Nd.' 58114 9 -
_
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
F
w ��
issued. `
Date *?Co,,tr,cto'c�
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 workerscompensation•
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier BENCHMARK INS Policy Number CSTS001638 -
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 w e ' compensation provisions of Section. '
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Cod I s7hall ith os rovisions. -, -
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation ofSection7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$500).:
zly
�s
Dat Applicant
(_) 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' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
y Contractors' State License Law does not apply to an owner of property who builds or -improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES 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
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 not build or
improve for the purpose of sale.). -
APPLICANT ACKNOWLEDGEMENT
•-1 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 contractor(s) 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, -
(_ 1 I am exempt under Sec. . B.&P.C. for this reason
- 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.
Date: Owner:
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
CONSTRUCTION LENDING AGENCY
permit to cancellation.
'
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
I certify that I have read this application and slate that the above formation is correct. 1 gree 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 ruction, and hereby ut orize epresen[atives -
- of this county to enter upon the above-mentioned property for i ecti purposes. ,
Lender's Name:
a
//r
Date` signature (Applicant or Agent):
.Lender's Address:
1 7N
• d -
-
,
I.OPERMIT
Application .Number. . . . . 13-00000662
Permit REMODEL 2013
- Additional desc .
Permit Fee;._:. 70.07 Plan Check Fee
.00 .
- ; Valuation
Issue:Date
0
e
Expiration Date 11/20/13
Qty. Unit Charge Per
Extension
_ . - 1.00' 48.6200 LS MISC .REMODEL, 1ST•. 100 SF 7
48.62
1.,00 21.4500 EA MISC;REMODEL,- ADDL 500 SF.
21.45
---- Special Notes and Comments`
RESIDENTIAL REMODEL AFTER SMOKE/FIRE -.
HALLWAY, LAUNDRY ROOM AND GARAGE. 2010
CODES:.
---
Other-:Fees BLDG STDS• ADMIN (SB1473)
1.00
PLAN CHECK, REMODEL
150:.15
STRONG MOTION (SMI) - RES
50
_ Fee summary Charged Paid Credited
Due
Permit Fee. Total 70.07 .00 .00
70.07
Plan Check Total .00 .00 -.00
.00
Other Fee Total 151.65 .00 .00
151.65
Grand Total 221.72 .00 .00
221.72
LQPGIL\11T _ _
-
Bin. #City.
Of LCA Quinta
Building 8t Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253.:(760) 777-7012
Building Permit' Application and Tracking Sheet
Permit #
2
Project Address:
Owner's Name:. o C
570
A. P. Number.
Address:
Legal Description:
City, ST, Zip:.
Contractor.C) ► I J S'
Telephone:
Address: -73 q5D i N 'S
j'', 3a2,
Project Description:
City, ST, Zip: 19f,
h ��(/Ll
Telepha ' 70 V --v '—Z%2e•
Stats Lie. #: LfCj _ City Lie'. #; rS�
C%l fi-• .fl
IR_ -
A 5z/6A
Or
Arch, Engr., Designer.
Address:
City., ST. Zip:
Telephone:
State Lie. #:
Name of Contact Person-
l:l
Construction Type:. Occepancy:
Project type (circle one): New Add'n . Alter Repair Demo
Sq. Ft.: # Stories: #Units:
Telephone # of Contact Person:(Z"
Cf j
Estimated Value of Project: SV-Z'V
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
' Rec'd
TRACMG
PERMrr FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit, .
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Calci.
Plana picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2;� Review, ready for correctionafissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Great Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`° Review; ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr '
Date of permit Issue
School Fees
Total Perm t Fees
r