BRES2016-034778-495 CALLE TAMPICO
LA QUINTA,,CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT ,
Application Number: BRES2016-0347
Property Address: 53725 AVENIDA VILLA
APN: 774133026
Application Description: STONE RESIDENCE / ADDITION 320 SF
Property Zoning:
Application Valuation: $40,000.00
Applicant:
JORGE GARCIA
45175 PANORAMA DR STE E
PALM DESERT, CA 92253
I
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/20/2017
Owner:
MARK STONE
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Cn
L7
53725 AVENIDA VILLA
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WORKER'S COMPERSATION DECLARATION
LA QUINTA, CA 92253
v
9 {commencing with Section 7000) of Division 3 of the Business and Professions Code,
I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect.
compensation; as provided for by Section 3700 of the Labor Code, for the performance
License Class: License No.: _
of the work for which this permit is issued
I have and will maintain workers' compensation insurance, as required by
Date: Contractor:
Section 3700 of the Labor Code, for the performance of the work for which this permit
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0. :
t�
Contractor:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
O
OWNER BUILDER
Z C
NO
compensation laws of California, and agree that, if I should become subject to the
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workers' compensation provisions of Secton 3700 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions.
Contractor's State License Law (Chapter 9 (commencing with Section 7000). of Division
Llc. No.: `
M
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
t 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. BAP.C. for this reason
11fDate: Ownerrfi/
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:
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby madeto the Building Official for a permit subject to
the conditions and restrictions set forth an 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 harmle°s the City of La Quinta, its officers, agents, and
employees for any act or omission relate -3 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 ;Ind state that theabove information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspectioa purposes. _ _ •A
Da Signature (ApAicant or Agent)4
s
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPERSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of.Chapter
I hereby affirm under penalty of perjury one of the following declarations:
9 {commencing with Section 7000) of Division 3 of the Business and Professions Code,
I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect.
compensation; as provided for by Section 3700 of the Labor Code, for the performance
License Class: License No.: _
of the work for which this permit is issued
I have and will maintain workers' compensation insurance, as required by
Date: Contractor:
Section 3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' compensation insi.rance carrier and policy number are:
OWNER -BUILDER DECLARATION
Carrier: Policy Number: _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Secton 3700 of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions.
Contractor's State License Law (Chapter 9 (commencing with Section 7000). of Division
�y
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
D�: Applicant V
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
WARNING: FAILURE TO SECURE WORKERV COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
�($5�).:
rrFFAAoorr�ff��SS 1, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
c pensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
t 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. BAP.C. for this reason
11fDate: Ownerrfi/
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:
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby madeto the Building Official for a permit subject to
the conditions and restrictions set forth an 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 harmle°s the City of La Quinta, its officers, agents, and
employees for any act or omission relate -3 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 ;Ind state that theabove information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspectioa purposes. _ _ •A
Da Signature (ApAicant or Agent)4
s
Application Number: BRES2016-0347
Property Address: 53725 AVENIDA VILLA
APN: 774133026
Application Description: STONE RESIDENCE/ ADDITION 320 SF
Property Zoning:
Application Valuation: $40,000.00
Applicant:
JORGE GARCIA
45175 PANORAMA DR STE E
PALM DESERT, CA 92253
Detail: ADDITION OF 320 SF LIVING AREA. PER 2013 CALIFORNIA BUILDING CODE
Owner:
MARK STONE
53725 AVENIDA VILLA
LA QUINTA, C.% 92253 .
Contractor:
OWNER BUILDER
Llc. No.:
Date: 3/20/2017
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ADDITION, EA ADDITIONAL 500 SF
101-0000-42400
0
$65.36
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ADDITION, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$18.24
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ADDITION, FIRST 100 SF
101-0000-42400
0
$127.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ADDITION, FIRST 100 SF PC
101-0000-42600
0
$179.:36::::j
Total Paid for ADDITION: $390.64
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - ESGIL PLANS EXAMINER
101-0000-42600
2
$180.00
Total Paid for BLDG CITY STAFF - PER HOUR: $180.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$2.00
Total Paid for BUILDING STANDARDS ADMINISTRAI ION BSA: $2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$152.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$50.16
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $202.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCE REPAIR/ALTERATION
101-0000-42402
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCE REPAIR/ALTERATION PC
101-0000-42600
0
$5.07
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FURNACE
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FURNACE PC
101-0000-42600
0
$25.33
Total Paid for MECHANICAL: $144.40
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
Total Paid for PLUMEING FEES: $38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$5.20
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $5.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS:40