13-0668 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-000666.8
Property Address: 78252 .HACIENDA LA QUINTA
APN: 646-280-003- - -
Application description_ : REMODEL - RESIDENTIAL
Property Zoning: LOW' DENSITY RESIDENTIAL
Application valuation: 10000
Applicant: Architectoorr Engineer:
4.4 a"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
LICENSED CONTRACTOR'S DECLARATION
I hereby affimn under penalty, of perjury that I am licensed under provisions of:Chapter 9 (commencing with
Section 70001 of Division 3 of th usin ss a r aslonels :Code,; my Lloense Is in' full force and effect:
License lass B -C27 License `684857
Date �'�q l3 Gontrector 6^-"-' .
OWNER -BUILDER DECLARATION
I hereby affirm,under penalty of,perjury that.bam exempt.from the Contractor's State License: Law for the
following reason (Sec. 703] L5, Busineas and Professioris;Code: Any city or county that.requires a psrmk',to
construct,.alter, improve, demolish, or repair any structure, .prior to Its°issuance,:also requires the applicant. for the
permit to,flles signed'statemermthat he or she is licensed pursuant to the provisions of the Comractor's State
License Law (Chapter 9 (commencing with Section 7000) of,Division 3 of the Business and Peofessions;Code) or
that he�or she is"exempt therefrom and the basis for the alleged exemption. Any vioiatlon,of Section 7031:5 by
any applicant for a permit subjects the'applicant.to a civil penalty of not more than five hundred dollars (8500).:
(_) 1„ -as owner of the property, or my employees with wages as their sole compensation, will dothe work, and
the structure is not•intended or offered for sale (Sec: 7044, Business;and'P.,rofessions Code: The
Contractors' State LicenseLaw does not apply'toan owner of property who builds or improves thereon,
and who does the work himself or herself'through his ocher own employees, provided that the
improvements -are notintended. or offered for sale. If, however, the building orimprovement;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 thepurpose of sale.).
(_ ( I, as owner, of the property, am exclusively contracting with, licensed 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 whocontracts” forthe:projectswith a cohiractorls),licensed
pursuant to. the Convectors' State License Law.).
1 _ 1 I am exempt under Sec. , BAP.C. for this reason
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:
OPERMIIT
Owner:
O':KEEFE
78252 HACIENDA
LA QUINTA, CA 92253
(
Contractor:
EDWARDS CONSTRUCTION INC,
51455 DESERT CLUB DRIVE
LA QUINTA, CA 92253
(760)777-8202
.LiC. No. 684.857
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/19/13
WORKER'S COMPENSATION, DECLARATION
I hereby�affirm under penalty of perjury, one of the following declarations:
_ I have and will maintain a cer ificate: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 permitis
issued.
I have.and will, maintain workers' compensation insurance, as required,by Section 3700.of:the Labor
Code, for the performance of the workfor which this;permitis Issued. My, workers' compensation
insurance carrier and policy number are:
Carrier BENCHMARK INS Policy Number WC1914223
_ I certify that, in the perforniance-of the'work for which this permit is issued; I shall not ernpioy.:any
person in -any manner so,asito become's_ubject to the workers'' compensation laws of California;
and 1 agree that, i"',sh d berlQma sub' the workers' compensation provisions of'Section 3700 of the Labor Co , I sl la►I fo ply with rhos pre ovisions:.
Date:& r Applicant: ('~
WARNING: FAILURE TO SECURE' WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONEHUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE, COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'SIFEES.
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 thisi application.
1. Each persoqupon whose behalf -this application is made, each'petson at whose request and for
whose benefit work is performed under or pursuant:to any permit•Issued.as a resultofthis application,
the owner; and the applicant, each agrees,to,.and shall defend, indemnify and hold harmless the City
of La Quints. its. officers, agentsend 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 Isnot commenced
within 180 days from date of issuance of such�permit, or cessation of work for 180 days will subject
permitto cancellation..
1 certitythat I have: read this application .end;state,that the,above information Is correct. I agree to comply with,all
city and county ordinances and state lawsrelating to building co tructio an _ ereby authorize re epr so tat,ves
of this eoymy Jo enter upon the above-mentioned pro ori p e rp Sea.
r
Date: ID I1 `'.7 Signature (Applicant or Agent);, �
Application Number . . . . . 13-0000066.8
Structure Information REPAIR FTS., INT REMODEL
Other- struct info . . . . . CODE EDITION
--------------------------------------------------------------------------------
2010
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 117.00 Plan Check Fee
76.05
Issue Date . . . Valuation . .
. 10000
Expiration Date . . 12/16/13 .
Qty Unit Charge Per
Extension
BASE FEE
45.00
8.00 9.0000 THOU BLDG.2,001-25,000
72.00
Permit.. . . REMODEL 2013
Additional desc .
Permit Fee . . . . 10.07 Plan Check Fee
.00
Issue Date . . Valuation . . .
0
Expiration Date 12/16/13
Qty Unit Charge. Per
Extension
1.00 48.6200 LS MISC REMODEL, 1ST 100 SF
48.62
1.00 21.450O:EA MISC REMODEL, ADDL 500 SF
21.4-5
---------------------------------------------
Special Notes and Comments
REPAIR FTGS DAMAGED BY TREE REMOVAL AND
INTERIOR STRUC. REMODEL PER 2010
CALIFORNIA BUILDING CODE.
June 19, 2013 11.:28:45 AM jjbhnson.
------
---------------- ---------------�-
Other Fees_.BLDG SIDS.ADMIN (SB1473
1.00
ENERGY REVIEW FEE
7.61
PLAN CHECK.,.REMODEL
150.15
STRONG MOTION (SMI) - RES
1.00
Fee summary Charged Paid Credited
-----------------
Due
------ --- ----------- ----------- -----------
Permit Fee Total 187.01 .00 .00
187.07
Plan Check Total 76.05 .00 :00
76.05
Other Fee Total 159.76 .00 .00
159.76
Grand Total 422.88 .00 .00
422..88
LQPERMIT