BRES2014-1053i
78-495 CALLE TAMPICO
°`LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
MONARCH HOMES
49950 JEFFERSON STREET
LA QUINTA, CA 92264
BRES2014-1053
53783 VIA PALACIO
777220012
EXT FIREPLACE ADDITION
$5,000.00
VOICE (760) 777-7125
D FAX 760 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 7/16/2014
Owner:
EARL FRAWNER
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
(commencing with Section 700 0'
of Divisio e B sin and Professions Code, and
my License is in full force and effect.
License CCla s: License No.: C28860 /
f •Date: ( ' Contractor: 5 V Q
OWNER -BUILDER TION
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 sighed
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.).
(_) 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.).
Lender's Name:
Lender's Address:
16764 BRIARCLIFF PT CIR
ANCHORAGE, AK 92253
Contractor:
MONARCH HOMES
49950 JEFFERSON STREET
LA QUINTA, CA 92264
(760)413-8863
Llc. No.: C28860
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:
Carr' r. _ Policy Number:
cer
I tify that in the performance of the work for which this permit is issued, I
shall not employ any person in any mag
er so as to become subject to the workers'
compensation laws of California, andZ"NbSATION
uld become subject to the
workers' compensation provisions ofe Labor Code, I shall forthwith
comply with th se provisions.
Date. / ApplicaG�S� ^ � D
WARNING: FAILURE TO SECURE WORCOVERAGE 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 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.
I agree to comply with all city and county ordinaQQkand state laws relating to building
construction, and hereby authorise representatives o ter upon the above-
mentioneo property for inspection purposes.
DaterSignature (Applicant or A nt): f�
[ , I Y.,,..f-D•�•,EsS2:•C-�,R._;Iy,PA,1:.TION:"7P .�F¢Y
FINANCIAL INFORMATION
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BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
<.s-''s}•'�PAID BY `'� fir`•"
m_METHOD� T";
�x:� RECEIPT # .'1,4r
CHECK #
CLTD BY `,
Total Paid forBUILDING STANDARDS ADMINISTRATION -BSA: $1.00 $0.00-
0.00
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PAID DATE':
—
HOURLY PLAN CHECK - YES
101-0000-42600
2.5
$175.00
$0.00
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s RECEIPT # �� r
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2` CLTD BY e
Total Paid forCITY STAFF - PER HOUR: $175.00 $0.00
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PAIDii=
PAID DATE,
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FIREPLACE
101-0000-42400
0
$143.00
$0.00
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SPA E..
ID DAT
FIREPLACE PC
101-0000-42600
0
$214.50
$0.00
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CHECK W,
a-CLTD B1F
Total Paid forFIREPLACE: $357.50 $0.00
" r r ;DESCRIP.TION y tl r r ,a
AFM -4 ACCOUNT"AMOUNTx
b
`PAID *>
.. .:
PAID DATE
SMI - RESIDENTIAL
101-0000-20308
0
$0.65
$0.00
METHOD'.CHECK#��>.ataCLTD
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BYE.
Total Paid forSTRONG MOTION INSTRUMENTATION SMI; $0.65 $0.00
TOTALS:•0
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DESCRIPTION' • QTY PAID
w .;yam 1Y "� �^Yar �. uvS Asa ✓"i .i y a m "i - � � tw fir. t k :.
PermItTRAKy
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34s5783VIAPALACIOR�-Apn 777220012f`s �
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m*BUILDINGSTANDARDSADMINISTRATION,'BSA
'�
BSAS SB1473 FEE 101-0000-20306 0 $1.00
'Sa $175:00]
HOURLY PLAN CHECK -YES 101-0000-42600 3 $175.00
g'"F a7- �,.' a ... S,� �.c y 4 . •
k �..w�_ Yro ,4.'t7. r
.xFREPAC
$357 50
FIREPLACE PC 101-0000-42600 0 $214.50
FIREPLACE 101-0000-42400 0 $143.00
'STRONG MOTION INSTRUMENTATION SIVA
SMI - RESIDENTIAL 101-0000-20308 0 $0.65
TOTAL FEES . ..
Date Paid: Wednesday, July 16, 2014
Paid By: MONARCH HOMES
Cashier: PJU
Pay Method: CHECK 1628
Printed: Wednesday, July 16, 2014 11:30 AM 1 of 1 CR GVCTF AAG