12-0713 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
c&t�t °F XP Q"
Application Number:- 12-00000713
Property Address: 78211 HACIENDA LA QUINTA
APN: 64,6-.280-016- - -
Application description: REMODEL RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 12100
Applicant: Architect or Engineer:
PIP
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
----------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed underprovisions of Chapter 9 (commencing with
Section 700) ofDNision 3 of the N3 lnes' d Ionals Code, and my License Iain full. forcephd.effect.
License �aasss. B C27 Llcense N 684857
/Date. —• [ `ontractor:
! 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 corimy that requires a permit to
construct;atter, 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 pursuamto the provisions of the'Contractor's.State
License Law (Chapter 9 (commending with Sect(on 7000) of Division3 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
anyapplicantfor a,permit subjects the applicant to'a civil penalty of;not more than five hundred dollars`( .500).:
I,.as;ownerof the property, or my employees'virith 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 Improvesthereon,
and who does the work himself or herself through his: or her own employeesprovided that She
Improvements are riot intended or offered for sale. If, however, the building or improvementis sold within
one year of completion, the owner -builder will have the burden of proving,that he or'she.did'not build or
improve foe the purpose of sale.).
(_ 1. I,:as_ .owner of the property. am exclusively contracting with Iicensed.contractors to eonstruet:the projecv(Sec.
7044, Business'and Professions Code:.The Contractors"State License.Law does not apply f6 an owner of
property who bullds,or improves thereon, and who contracts for the:projeots with econtractor(s) licensed
pursuant,to the Contractors' State License Law,I.
(_ 1 I am.exampt under Sec. B4P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty,of perjury that -there Is a constructlonlending agency for the performanceofthe
work for which this permit Is issued ISec: 3097, Civ. C.).
Lender's Name: Ijy
Lender's Address— r 1"
LQPERHIT
Owner:
OKEEFE,JOHN V & KATHLEEN J
78211 HACIENDA LA QUINTA
LA QUINTA, CA 92253
VOICE (766) 777-7012
FAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Date: 8/21/12
Contractor:
EDWARDS CONSTRUCTION I r BOBAUG 2 12012
51455 DESERT CLUB DRI
LA QUINTA, CA 922,53
(760),777-8202 CITY'01FLAQUINTA
LiC,. No.: 684857 FINANCE DEPT..
WORKER'S: COMPENSATION DECLARATION
I, hereby affirm under penalty of perjury one of the following,declarstions:
— I have:and will maintain a certificate of consentto;self insure for workers`bompensatlon„as,provided
for'.by Section 3.700 of the Labor Code; for the performance,of,the work for which this permit Is
Issued.
$-r-I have and will maintain workers'•compensetion,insurance, as required by Section,3700 of the Labor
Code, for theperformance of the work for which thls permit is issued. My workers' compensation
insurance carrier and policy number are:
Carrier GRANITE STATE Policy Number WC1914223
_ I certify that, In the performance of.the work:for which this permit is issued, I shall not employ any
person inany'mannerso as to become subject to the workers' compensation'laws of California;.
and.agree that, if I ddb ome s ject to the workers' compensation provisions of Section
'j 3700.ofthe -bor o s; 1 I1fc ith, mply with,thoslprovisions..
/, _r 1� - plicant
WARNING: FAI RE TO. SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMP,LOYER'TO CRIMINAL PENALTIES:AND CIVIL FINES'.UP TO ONE'HUNDRED THOUSAND
DOLLARS,(9100,000); IN ADDITION TO -THE COST OF COMPENSATION, DAMAGES,AS PROVIDED FOR IN
SECTION 3706 OF THEIAbOR CODE, INTEREST, AND.ATTORNEY'S FEES.
APPUCANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permlt;subject to the
et
conditions and restrictions SM
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 pursuantto any permit issued as'a result of this application;
thwowner;'endAhe applicant; each�agrees to, and shall defend, indemnify and hold harmless the City
of La Quints, Its officers; agents and employees for any act or omission related to the work being_
performed tinder orfollowing issuance of,this permit.
2.; Any'permit issued.as a result of this application becomes null and void If work isnot commenced
within 180 days from data of issuance of such permit, or cessation of work for 180 days will subject
,permit to cancellation.
I certify that l have read this applicatiomand statethat the above Information is correct. I; agree to comply.wlth all
city and cos ordinances and state laws relatlrg to b ' g ru _ hereby;authorize' presentatives
Zf-e:
Is unt2 elmer upo the above-mentioned prope fo i pu es..
V naturw(Applicant or. Agent):
J
-%`
Application Number . . . . . 12-0000.0713
----- Structure Information INTERIOR REMODEL
-=---
Other struct info .
. . CODE EDITION
2010
Permit . . . BUILDING PERMIT
Additional desc . .
Permit- Fee .. ..
144.00 Plan Check
Fee
93.60
Issue Date . . .
Valuation
1210.0
Expiration Date
2/17/13•
Qty Unit Charge
Per
Extension
BASE FEES
45.00
11.,00 9.0000
THOU BLDG 2,00:1.-25,000
99.00
PermitELECT - ADD/ALT/REM
Additional•desc .
Permit Fee
21.00 Plan Check
Fee
5.25
Issue Date
Valuation
0
Expiration Date
2/17/,13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
8.00 .7506
PER ALEC'DEVICE/FIXTURE 1ST 20
6.00.
Permit. . . . MECHANICAL
Additional desa
Permit Fee
2.4.00 Plan Check
Fee
6.06
Issue Date
Valuation
0
Ex- 'r Date
2/17/13
Qty. Unit Charge
Per,
Extension
BASE FEE
15..00
1.00 9.0000
EA MECH APPL REP/ALT/ADD
9..60
Permit. .. . . PLUMBING
Additional,desc .
Permit Fee . . . ..
21.00 Plan Check
Fee
5.25
Issue Date . . . .
Valuation
.,
0.
Expiration -Date
2/17/13
Qty Unit Charge
Per
Extension
BASE:FEE
i5.00
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.,00
1,.00 3.000.0
EA PLB FIXTURE DRAIN/VENT
REP/ALT.
3.00
El v
Application Number . . . . 12-0:00.00713
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Special Notes and Comments
REMODEL TO KITCHEN, LIVING -ROOM FIRE
PLACE, AND MASTER BEDROOM ENTRY
[ENGINEERED] THIS PERMIT DOES NOT
INCLUDE ADDITIONAL CONDITIONED SQUARE
FOOTAGE. 2010 CALIFORNIA BUILDING CODES..
August 21, 2012 10:06:36 AM AORTEGA
------------------.----------------------------------------------------
Other Fees BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW
FEE
9.36
Fee summary Charged Paid
- ----------- ---- -- - ----------------
Credited
Due
Permit Fee'Total 210.00 .00
------
.00
2,10.00
Plan Check Total 110.10 .00
.00
110.10
Other Fee. Total 10.36 .00•
.0.0
10.36
Grand Total 330.46 .00
.00
330.46
LQPFrr
Bhi-.
City of La Quints
Building 8 'Safety Division
P.O. Box 1504, 78-495 Calle Tampico.
La Quinta, CA 92253'--(760) 777-7012
Building Permit. Application and Tracking Sheet .
Permit #
Avb
Project Address:
Owner's Name:
A. P. Number.
Address: r
Legal •Description
City, ST, Zip:
Contractor.
_Lr4�4e�aAI_
Addpess Jr . ,-
Telephone: _
Project Description: •
. City, ST, Zip: tn' S3
State Lic. # :
City Lic. #:
Arch., Eng, Designer.
Address:
City, ST, Zip:
Telephone: Q G "Construction
State Lic: #: " �, Q� Ji
Name,of Contact Person:-
Type: Occupancy:
Project type (circle one)): New n ter av Demo
Sq:: Ft:: #,Stories: # Units:
Telephone # of Contact Person:
Estimated Value o ed..
APPLICANT:, DO NOT, WRITE BELOW THIS L1
#
Submittal.
Req'd _ ..
Recd
TRACING.
PERMIT FEES
Seta
77
Plan Check submitted
wMplan
Item
Amount
StructarRICalcs:
Reviewed, ready for corrections
'Plan Check 'Deposit'
Truss Cases.:
Called Contact Person AV
Plan Check Balance
Ener® Calcs.
Pians Picked up �� (
Construction -
Flood plain plan
Plans resubmitted
Mechanical
Grading plan..
20° Review, ready for'correctio
Electrical
Sabcontactor.Ltst
Called Contact Person 0-1
'Plumbing
Grant Deed`
Plans picked up
S dK L
E.OA. Approval;
Plans resubmitted _
-Grading
IN EOUSE:-
'"' Review, ready for correctionslissue
Developer Impaet•Fee
Planning Approval
Called Contact Person
.P.
Pub. Wks. Appr
Date of permit issue
School Fees
-
-- — _.-
Total Permit Fees
11* low. - nlvta. i