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10-1255 (RER)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 10-00001255 Property Address: 81420 GOLF VIEW DR APN: 762-410-019- - - Application description: REMODEL - RESIDENTIAL Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 30000 T4'yl 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: BLOESSER REX/SLATER POLLY 18042 NE 132ND ST REDMOND, WA 98052 (002)000-0000. Contractor: Applicant: Architect or Engineer: DE CHRISTOPHER, INC. 42575 MELANIE PL, STE C PALM DESERT, CA 92211 cgnno1K70� N� (760)346-3838 No.:4 N LiC. No.: 428701 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 Busin s and Profession Code, and my License is in full force and effect. License Class: B Licens N .: 428701 KDate: Contractor: I OWNER- D R CLARATION I hereby affirm under penalty of perjury that 1 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 1$500).: (_ 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 safe (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.). 1 ) 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: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 11/23/10 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: Carrier EXEMPT Policy Number EXEMPT 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 the workers' compensation laws of California, and agree that, if I should become subject to th�rlkers' compensation provisions of Section ���� 0of the Labor Cod I shall forthwith h those provisions. Date J Applicant: +/J WARNING: FAILURE TO SECURE WORKERS' COM SATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 1$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 Ouinta, 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 inforsm'on is correct. I agree to comply with all city and county ordinances and state laws relating to building nst ct hereby authorize representatives of thisrty f ihicounty to enter upon the above-mentioned propens Dat�z)J Signature (Applicant or Agen ): Application Number . . . . . 10-00001255 ------ Structure Information LIVING ROOM REMODEL - NON-STRUCTURAL . ----- Other struct info . . . . . CODE EDITION 2007/2008 ---------------------------------------------------------------------------- Permit . . . BUILDING PERMIT Additional-desc . Permit Fee . . . . 284.50 Plan Check Fee 184.93 Issue Date . . . . Valuation . . . . 30000 Expiration Date 5/22/11 Qty Unit Charge Per Extension BASE FEE 252.00 5.00 6.5000 THOU BLDG 25,001-50,00.0 32.50 --------------------"-------------------------------------------------------- Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 28.50 Plan Check Fee 7.13 Issue Date . . . . Valuation. . . . . 0 Expiration Date 5/22/11 Qty Unit Charge Per Extension BASE FEE 15.00 18.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 13.50 --------------"-------------------------------------------------------------- Permit . . . . . PLUMBING Additional desc . Permit Fee 18.00 Plan Check Fee 4.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 5/22/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 " 3.0000 EA PLB GAS PIPE 1-4 OUTLETS 3.00 ---------------------------------------------------------------------------- Special Notes and Comments LIVING ROOM REMODEL - RELOCATE FIRE PLACE (INCLUDING REVISING NICHE FRAMING), RELOCATE/ADD LIGHTING AND ADD FAUX WOOD BEAMS AT. CEILING. 2007/2008 CALIFORNIA BUILDING CODES. November 23, 2010 10:09:03 AM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . .. BLDG STDS ADMIN (SB1473) 2.00 ENERGY REVIEW FEE 18.49 Fee summary Charged . Paid Credited Due LQPERMIT Application Number . . . . . 10-00001255 Permit Fee Total 331.00 .00 .00 331.00 Plan Check Total 196.56 .00 .00 196.56 Other Fee Total 20.49 .00 .00 20.49 Grand Total 548.05 .00 .00 548.05 I.QPERMIT r CITY OF LA QUINTA SUB -CONTRA TOR LIST � G1'�il�l S �°f".Z#xXj )V116a JOB ADDRESS F/ V-2 0 GOA4 V>P ��. PERMIT NUMBER _OWNER ��c ,� BUILDER �i L'' G �� This form shall be posted on the job with the Building Inspection Card at all times in a consaicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to tjlis list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acc table response. Fodriton .Ak609 Codipany Name Class(tication License Number Exp. Date Carder Name Policy Number Exp. Date License Number Exp. Date (e.g. A. B. C -S) (xxxxxx) (xxixx/xx) (e.g. State Fund, CelComp) (Format Varies) (xx/xx/xx) (xxxx) (xx/xxlxx) EAR�I'HW4RK (C=1zi �� //P Ow.,� atllASO[R1f IG.=28�) -J 'I:ATNi :PIA&TSR .1�3�1: 4i o'Wn ccCt G �J ,� 1kR,l .M a t 040. sx aN&{A R .-10 ) yi L 4,G3) cSWF p J 5 �� y -64- ;U1ND$kAlN�:a;C-271:.:: ; 'POOL-1 S J Bin # `may, Qty Of is Quinia Building 8t' Safety Division P.O. Box 1504, 78-495 Calle Tampico La Qulnta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: 01-407-0 (SO GP Owner's Name: ✓ If A. P. Number: Address: VIE (,J Legal Description: City, ST, Zip: Contractor: V-rLVe-ri rl �� �, Address: —57 Rel /• *C, Telephone: Project Description: City, ST, Zip: • A L- ./ J Telephone: .o State Lie. # :4.29'701 City Lie. #: J Arch., Engr. esigner Address: City., ST, Zip: ^� Telephone: /1/` ' ' .:<. 4 ,�•. �. Construction Type: Occupancy: State Lie. #: ircle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft : #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: � 000 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets 3 Plan Check submitted 11/17 �p Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. 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 corrections/issue Electrical Subcontector List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''4 Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees L�ITotal Permit Fees APPLICATION # jr).17 ADDRESS -qso Gm.F By VALUATION 1st FLOOR 2 ad FLOOR COVERED PATIO GARAGE TYPE CONST: OCCUPANCY A/C FIRE SPRINKLER # OF. BEDROOM FLOOD ZONE ff :OF -UNITS CODE EDITION ROOF TYPE MECHANICAL VENT FANS EXHAUST HOOD A/C <3 TON A/C >3 TON FAU <100,000 BI FAU >100,000 BI DUCT ALTERATIOt # OF FIXTURES SEVER SEPTIC SYSTEM ROOF DRAINS WATER HEATER WATER PIPING LAWN SPRINKLEF GAS PIPING 1-4 GAS PIPING >4 GAS METER I SQ. FT. UNIT COUNTS GAS TOILETS ao Vhl- BIDET SHOWERS BATHTUBS. ttq.T te SINKS BARSINK BBQ OVEN - RANGE �- COOKTOP DRINKING FOUN WASHER DRYER WATER HEATER ROOF DRAINS FLOOR DRAINS KITCHEN SINK VEG SINK LAUNDRY SINK FIREPLACE F F. FCr R TCA T, I..L V GARAGE SQ- FT TEMP POWER FIXTURE # GRADING <50 CU YDS >50 CU YDS CDD APPROVAL ENGINEER APP.