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14-682 (RER)TAMPICO LA QUINTA, CALIFORNIA 92253 *.Application,Number: Property -Address: APN: Application Description: Property Zoning: Application Valuation: COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT RER-14-682 77182 CALLE FLORA 658210012 REMODEL GARAGE DOORS, CHANGE OPENING $50,000.00 Applicant: GOLDEN CONSTRUCTION INC, PAUL 0 OUTSIDE CITY LIMITS LA QUINTA, CA 92253 A JAN 2O2015 CITY OF LA QUINTA COMMUNITY DEVELOPMENT DEPARTMENT LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: _ License No.::LIC-00057d716'� ate; � ntractor• OWNER -BUILDER DECLARATION 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.). ( ) 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: FA Lender's Address: VOICE (760) 777-7125 FAX (760) 777-IV17 INSPECTIONS (760) 777-7153 Date: 1/23/2015 Owner: ROBERT MILLER 838 SW 1ST AVE ST€: 210 PORTLAND, OR 0. Contractor: GOLDEN CONSTRUCTION INC, PAUL 0 OUTSIDE CITY LIMITS LA QUINTA, CA 92253 (760)776-4220 L•Ic. No.: :LIC -0005737 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate d consent to self -insure for workers' compensation, as provided for by Section 3700 d 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 performz nce of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier:_ Policy Number: _ I certify that in the performance of th 2 work for which this permit is issued, I shall not employ any person in any manner so alto become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3]C0 of the Labor Code, I shall forthwith comply with hose provisions. // J/ /� Date g- t / / pplicant:L.( WARNING: FAILURE TO SECURE WORKERS' COM DENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINA_ PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000)- IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR I J SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOW -EDGEMENT 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 applicaeion 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 applical€ion becomes null and void if work is not commenced within 180 days from date of is: uance 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 ordinances and state laws relating to building construction, and hereby authorize representatives of this city upon the above- • mentioned pr party for inspection purposes. / Date: .1 nature (Applicant or Agent): `'�� 1 t 0 • l ®WE..-- -'�D�ESCRI�P�T1�0�AC OUB N �AMO�UNT` �PA1D PAID D�A�E� BSAS 561473 FEE • -, 101-0000=203060 $2:00 - $0.00 gg ' PAIDBY .,..00 s �� _R, AM�� RECEL#CK# , CITiB1L.. ., ,. . � Tota - d for. BUILDING STANDARDS ADMINISTRATION BSA $2.00 - $0:00. "�•^' ",'�-s s DESCRIPTIONS u:� j :; ACCOUNT zq QT99Y t'�.�rdui... AMORT • PAID$PAID DATE 3ti 2�XSu?3 . Y.iWn i..�'.4Y� k FIXTURES,FIRST'20 101-0000-42403 1 $24.17 $0.00:1" PAID BY Y METHOD RE E T# HECK# LT l .€ �.. 4 WMO�UNT ;PA �A D A �..;.DESCRIPN��.aACU FIXTURES, FIRST 20 PC 101-0000-42600 1 ' $24.17. $0.00 ' PAI .. � mss, METHOD. RECEE1 m # CHECK # .° : CL D�BY ... . �' Total Paid for ELECTRICAL: _ : $48.34. $0.00 <' DESC OWN= A000UN QTY J AMOUNT r PAID r PAID DATE HOURLY PLAN CHECK 10160003428200 $52.50 :$o qo PAIBY.. 'MUM METHOD REC IPT# ��, CHEC #Y CLTDBY�.= Total Paid forHOURLY,PLAN CHECK:. ' `. $52.50' $0:00 . , `DESCRIPTION�1 4" CCOUNT .... #.� � PLAN CHECK; ELECTRICAL 10160003428200 $23.83 $0.00 PAID BY MET�H�U �.��. RECEI # CH CK�#��..x �L Total Paid; for PLAN CHECK, ELECTRICAL:$23.83 $0:00 4 DES�CRIP�T ON'.:' �. A T Q A OUNT PAID PAID DATE REMODEL, FIRST 100 SF 101-0000-42400 0 $49.31 $0:00 w PAIDrBY � METHOD 1'0 z� ;, RECEIPT # ti. ate. CHi 44 CL�T.D BY ��DESCR TION „ tet„ a� COIJNT'� N AMOUNT,11 PAIDx PAI,O�DATE REMODEL, FIRST 500 SF PC 1017m0000-42600 0 - $134:88 $0:00 PAIDBY MINEIN N sr ETH�OD x�wu:cr x YRECEIPT# a.- CHECK# CLTDBY Total.Paid forREMODEL: V $184.19 % • $0.00. r- DESCRIPTION AC O NT T TY AMOUNT ' PAID P D DATE, SMI -RESIDENTIAL' 101-0000-20308 0 $6.50 $0:00. BY �' -'CETHODz Q w ° s *max ECEIPTx# HECK # are CLTD BY ^ ahs Total Paid forSTRONG MOTION INSTRUMENTATION SMt $6.50 - $0.00 Description: REMODEL GARAGE DOORS, CHANGE OPENING ADDITIONAL Type: BUILDING, RESIDENTIAL Subtype: REMODEL Status: OK TO ISSUE Applied: 5/22/2014 Approved: 6/11/2014 Parcel No: 658210012 Site Address: 77182 CALLE FLORA LA QUINTA,CA 92253 Subdivision: Block: Lot: Issued: Lot Sq Ft: Building Sq Ft- Zoning: Finaled: Valuation: $50,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: No. Stories: No. Unites: Details: REMODEL GARAGE, CHANGE OPENING SIZE. CONDITIONS j Applied to. Approved Printed: Friday, January 23, 2015 11:15:31 AM 1 of 3 SYSTEMS ADDITIONAL CHRONOLOGY TYPE STAFF NAME LHKUNULUlby ACTION DATE COMPLETION DATE NOTES TELEPHONE CALL JIM JOHNSON .1/13/2015 1/13/2015 CALLED GOLDEN CONSTRUCTION TO INFORM THEM THEIR LIC. HAS EXPIRED AND PLANS ARE READY TO ISSUE. - CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP' PHONE FAX EMAIL CONTRACTOR GOLDEN CONSTRUCTION INC, PAUL 0 OUTSIDE CITY LIMITS LA QUINTA CA 92253 OWNER ROBERT MILLER 838 SW 1ST AVE STE PORTLAND OR 0 210 Printed: Friday, January 23, 2015 11:15:31 AM 1 of 3 SYSTEMS DESCRIPTION ACCOUNT' ry QTY, AMOUNT PAID PAID DATE RECEIPT #" CHECK # METHOD: PAID BY W CLTV BY; BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00 Total Paid forBUILDING STANDARDS ADMINISTRATION $2.00 $0.00 BSA: FIXTURES, FIRST 20 101-0000-42403 1 $24.17 $0.00 FIXTURES, FIRST 20 PC 101-0000-42600 1 $24.17 $0.00 Total Paid for ELECTRICAL: $48.34 $0.00 HOURLY PLAN CHECK 10160003428200 1 $52.50 $0.00 Total Paid forHOURLY PLAN CHECK: $52.50 $0.00 PLAN CHECK, 10160003428200 $23.83 $0.00 ELECTRICAL Total Paid forPLAN CHECK, ELECTRICAL: $23.83 $0.00 REMODEL, FIRST 100 SF 101-0000-42400 0 $49.31 $0.00 REMODEL, FIRST 500 SF 101-0000-42600 0 $134.88 $0.00 PC Total Paid for REMODEL: $184.19 $0.00 SMI - RESIDENTIAL 101-0000-20308 0 $6.50 $0.00 Total Paid forSTRONG MOTION INSTRUMENTATION SMt $6.50 $0.00 TOTALS:00 INSPECTIONS Printed: Friday, January 23, 2015 11:15:31 AM 2 of 3 SYSTEMS STRUCTURALI BUILDIN 11/13/2015 11/28/2015 11/13/2015 I APPROVED I APPROVED I BOND INFORMATION ATTACHMENTS Printed: Friday, January 23, 2015 11:15:31 AM 3 of 3 CRWIYSTE'MS Building Address P.O. BOX APPLICATION ONLY TAM 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 nv- BUILDING: TYPE COONT.P. SOCC. GR A.P. Number (` d SO .2Z 0 O /.2 –7 Zip el. �� Legal Description C4417 141 4-1/47 d 0 Project Description 6S2.4 e � r Zip Tel. ;%fi o 9LI-I 1 7111- - Vas&_ & Classif. Lic. # Arch., Engr., Designer,p„ L T_ r+uurGss lel. 760 P Zip State O Lic. # LICENSED CONTRACTOR'S DECLARATION Ihereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contrac- tor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he 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, 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 Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such 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 did not build or improve for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply. to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & PC: for this reason Date Owner WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company O Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less). 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 Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 ordinances and state laws relating to building construction, and hereby authorise representatives of this city to enter the above-mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT Sq. Ft. No. Size Sto No. Dw. New ❑ Add ❑ Alte4l Repair ❑ Demolition ❑ I Estimated Valuation C 3X5—D/ Dao PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure k AV 02 2014 ern eF LA QUI TOTAL CONTACT INFORMATION NAME: PHONE: ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line — FINAL DATE INSPECTOR Issued by: Date Permit_ Validated ,by: Validation: YELLOW = APPLICANT PINK = FINANCE 11 I3jn # Permit # Project Address: r77— 1 City of La Quinta Building 81: Safety Division P.O. Box 1504, 78-495 Calle Tampico. La Quinta, CA 92253 - (760) 777-7012 Building Per /�.�plication and Tracking Sheet Q� Owner's Name: A. P. Number: Address: Legal Description: City, ST, Zip: Contractor: Telephone: Address: Project Description: City, ST, Zip: Telephone: €f?` State Lic. # : Arch., Engr., Designer: City Lic. #•: VJ t Address: affi City., ST, Zip: Telephone: Occu anc Construction Type. yP • P Y: State Lic. # ::.s.;: F:.;;:::::>;;;:::.;:.;;;n>•; :; :::: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: #Units: Telephone #,of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Recd TRACKING PERMIT FEES. Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mecham 1 �� Grading plan 2°" Review, ready for corrections/issuedft 114Electric O Subcontactor List Called Contact Person Plu bing OSS Grant Deed Plans picked up S.M dDo H.O.A. Approval Plans resubmitted G ading IN ROUSE:- Review, ready for correctionsrassueeveloper L1n Planning Approval Called Contact Person A.T. .P. r Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees