BRES2016-001478-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/28/2016
Application Number:
BRES2016-0014
Owner:
Property Address:
53780 AVENIDA HERRERA
'BRIAN HARMS
APN:
774164002
Property Zoning:
Application Valuation:
$9,000.00
Applicant:
CUSTOM CLAIMS RESTORATION
404 CALLE CAPANERO
SAN CLEMENTE, CA 92673
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: B License No.: 947404
Date: - 2 Contractor:
OWNER -BUILDER DECN
I hereby affirm under penalty of perjury that I am pt 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 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:
Contractor:
CUSTOM CLAIMS RESTORATION
404 CALLE CAPANERO
SAN CLEMENTE, CA 92673
(917)575-2949
LIC. No.: 947404
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: Policy Number:
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 the
workers' compensation provisions of Section 3700 of the Labor de, I shall forthwith
comply with those provisions.
Date: i1 c Applicant:
WARNING: FAILURE TO SECURE WORKERS' COM PENSA I N COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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 Building Official 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 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 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 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 inspection purposes.
Date: 2 �c (a Signature (Applicant or Agent):
E.a
•• •
BSAS SB1473 FEE 101-0000 20306'. 0 <, ° $1.00 $1.00 1/28/16
f" <"' ".ro ,4C§;.kS;gq:�S•w-S'e Y-a<'''tTk `<^xk ka ._iyR "'Ga
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CUSTOM CLAIMS RESTORATION DEBIT R12422 AOR
Total Paid'for BUILDINGSTANDARDS ADMINISTRATION BSA: . $1.00< '. .$1 .00.
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,DESCRIPTION�r�m�
etam.r`�aza..#.f`tte«_,..Wu..1ev..P.C..Nsw'....a.: �.v<'v _e<
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.,DEVICES, FIRST 20
101=0000=42403
0 $24.17, .;`
$24.17
1/28/16
METHOD
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CUSTOM CLAIMS RESTORATION
DEBIT
R12422' '
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DESCRI?TION1daYA000UNT'E%
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DEVICES,,FIRST20"PC
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101=0000-42600 ,;
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1/28/16
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CUSTOM CLAIMS RESTORATION
DEBIT �'d' T,
.h 'i~, "R12422 t fr
AOR
Total Paid for'ELECTRICAL:, $48-34"." $48.34 f
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101-0000-42400.0
'$72 52 �.,,
$72.52.
;1/28/16'
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CUSTOM'CLAIIVIS RESTORATION
DEBIT' ',
1112422
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PAID
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PAID DATE"
��DESCRIPTION��
:.... •m _:.i�"'?.«.._..i_..a%'...<k.:X V...$l..acL,.�
;�4 ,QTY
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0
$133.43., •'•
$133.43.
1/28/16
40 PAID.BY
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CLT.D.
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CUSTOM'CLAIMS RESTORATION
MEBIT
R12422 :
AOR
,Total. Paid for,PARTITION: 295.95 � $205.9S:,,
-Y Y';�..'x ,n� S.R. ,'.kY. s � ^ra,. 'x..'�`_ ".�•..�
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€ACCOUNT
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PAID 'N'
PAIU:DATE'
r , 'DESCRIPTION
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WATER HEATER/VENT
-101=0000-42401
.0
$12:09.
$12.09
1/28/16 .;
a� x
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:CLTD
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CUSTOM CLAIMS RESTORATION
': DEBIT
�'- 1112422
-AOR
,,
�iDESCRIPTIQN���ACCOUNT�YQTY�AMOUNTMir
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PAID DATE:
»P
_-
WATER HEATER/VENT-PC
101-0000-426000
$7 25 ";
.$7,25',_
1/28/16
r PAID BY
METIOD�RECEIPT#�
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CHECKg#
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ACLTO
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CUSTOM CLAIMSRESTORATION
DEBIT
'1412422'
AOR
Total'Paid for PLUMBING FEES: .'$19.34 $19.34
v J {•r cc:<,i ^!1?v r_ .i:.( '2 tN' ,x° ±'4f ' ..-Et i i
�DESCRIPTION�a�
PAI
i77 7 77
PAIUDATE
f?
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QTYAMOUN73<y-`Oi
Dl, �5s
SMI _.RESIDENTIAL
r ' 101-0000=20308
0
$1.17
$1.17,28/16
IF.Y $. s"-3"<ied .A'"8: .h w«'CEiafC.e9>".v:.. 'a RF'cn ,\.,% A
}fix. '' « -£3 f s�^:.<< t4oS?: !^"'('y�i 'x'W h
PAIDrBYY
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RECEIPT,# �
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CHECK#
CLTD BYE
1�1
METHOD r
{ 3 i*
t
y
;
CUSTOM CLAIMS RESTORATION'
EBITi
1112422
.-'.AOR `.
Total Paid for STRONG MOTION INST RUMENTAT10N'SM I: ',$1.17` '• $1:17•
Description: HARMS / FIRE DAMAGE REPAIR AT GARAGE [NON-STRUCTURAL]
Type: BUILDING, RESIDENTIAL Subtype: REMODEL Status: ISSUED
Applied: 1/28/2016 AOR
Approved: 1/28/2016 AOR
Parcel No: 774164002 Site Address: 53780 AVENIDA HERRERA LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 238 Lot: 23
Issued: 1/28/2016 AOR
UNIT 22
cHkONOLOGY
Lot Sq Ft: 0 Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $9,000.00 Occupancy Type: Construction Type:
Expired: 7/26/2016 AOR
No. Buildings: 0 No. Stories: 0 No. Unites: 0
Details: FIRE DAMAGE REPAIR AT GARAGE, INCLUDING CHANGEOUT OF EXISTING WATER HEATER. THIS PERMIT DOES NOT -INCLUDE
ALTERATION TO EXISTING LATERAL RESISTING SYSTEMS, ENGINEERED TRUSSES, OR MECHANICAL SYSTEMS. 2013 CALIFORNIA
BUILDING CODE.
Printed: Thursday, January 28, 20161:29:23 PM 1 of 3 C1"
SYSTEMS
ADDITIONAL
cHkONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI CITY
STATE
ZIP PHONE FAX EMAIL
APPLICANT
CUSTOM CLAIMS RESTORATION
404 CALLE CAPANERO SAN CLEMENTE
CA
92673
CONTRACTOR
CUSTOM CLAIMS RESTORATION
404 CALLE CAPANERO SAN CLEMENTE
CA
92673
OWNER
BRIAN HARMS
PO BOX 841 1 COBB
CA
92253
Printed: Thursday, January 28, 20161:29:23 PM 1 of 3 C1"
SYSTEMS
PARENT PROJECTS
Printed: Thursday, January 28, 2016 1:29:23 PM 2 of 3 R
SYSTEMS
rRECEIPT
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
' PAID DATE
#
CHECK #
METHOD
PAID BY
BY
DEVICES, FIRST 20
101-0000-42403 -
0
$24.17
$24.17
1/28/16
R12422
DEBIT
CUSTOM CLAIMS
AOR
•
RESTORATION
DEVICES, FIRST 20 PC
101-0000-42600
0
$24.17
$24.17
1/28/16
R12422
DEBIT
CUSTOM CLAIMS
AOR
RESTORATION
Total Paid for ELECTRICAL: $48.34 $48.34
PARTITION -
101-0000-42400
0
$72.52
$72.52
1/28/16
R12422
DEBIT
CUSTOM CLAIMS
AOR
RESTORATION
PARTITION PC
101-0000-42600
0-
$133.43'
'$133.43
'-1/28/16 '
'1112422
DEBIT
CUSTOM CLAIMS
AOR
RESTORATION
Total Paid for PARTITION: $205.95 $205.95
WATER HEATER/VENT
101-0000-42401
0
$12.09
$12.09
1/28/16
R12422
DEBIT
CUSTOM CLAIMS
AOR
RESTORATION
WATER HEATER/VENT
101-0000-42600
0
$7.25
$7.25
1/28/16
R12422
DEBIT
CUSTOM CLAIMS.
AOR
PC
RESTORATION
Total Paid for PLUMBING FEES: $19.34 $19.34
SMI - RESIDENTIAL
101-0000-20308
0
$1.17
$1.17
1/28/16
R12422
DEBIT
CUSTOM CLAIMS
AOR
RESTORATION
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.17 $1.17 '
TOTALS::0 $275.80
PARENT PROJECTS
Printed: Thursday, January 28, 2016 1:29:23 PM 2 of 3 R
SYSTEMS
APPROVED BASED ON SCOPE OF WORK
1ST BLDG NS (1 PROVIDED BY APPLICANT (JEFFREY RUIZ) AND
DAY) AJ ORTEGA 1/28/2016 1/29/2016 1/28/2016 APPROVED THE PICTURES ATTACHED TO THE DO NOT
OCCUPY RECORD, INSPECTOR TO VERIFY WORK
BEING DONE OUTSIDE OF SCOPE PERMITTED.
ATTACHMENTS
Printed: Thursday, January 28, 2016 1:29:23 PM 3 of 3 CRE".
Sin #
Qty of La Quinta
Buifding & Safety Division
78-495 Calfe Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Uwlio -oo 14
Project Address: 3' g p UC h %c4 4 4CV-rtr'C4.
Owner's Name:
A. P. Number:
Address: 3 0 r
Legal Description:
City, ST, Zip: 64 at J
c, 04
r
Cont actor: V x� c 1R1 W�,cS
5 5
Tele P h one:
Address: uQ Cj,-y I C�M�A MQ co
Project Description:
City, ST, Zip: 13N C�N�tOw lC'�1 2(- -73
Telephone: S a
h
State Lic. # : q C4
City Lie. #.:
wt�►fti
')
Arch., Engr., Designer:
M1K1_ r •. Ma"
Address:
City., ST, Zip:
ne:
Telephone: ho
...........................:.............::::::::::.:.
Occupancy:
Construction n T e• u
s o YP P Y:
State te Li c. #
Project type circle one): New Add'n Alter De mo
Name of Contact Person: ��
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: Al °j O O
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item •
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical .
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
Jrd 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,
Total Permit Fees
CITY OFLA QUI A
BUILDING & SAFETY D PT.
ley APPROVE
FOR CONSTRUCTIO
i� DA 8Y
Cjf � '6tawlotb• i9pt� — F►�
53-*1SO ktZo1ak 4k'9
- DANGER -
Do Not Occupy
THIS BUILDING IS UNSAFE AND/OR UNFIT FOR
HUMAN OCCUPANCY
It is unlawful for any person to occupy or reside in this building
per LQMC 1111.72.030 (M)
Address:_ 53-780 AVE IDA 4EFZW,E5;;Z'A.
The owner must correct all violations which may include boarding and securing to FHA standards.
Failure to correct' cited violations will result in City action to correct violations and placement of a
lien upon property until said costs are paid.
Costs for correction by the City include, but are not limited to:
• Administrative Expenses • Staff Expenses
• Actual costs, including: Attorney Fees, Hearing Officer fees, and Proceeding set-up fees
Any cost incurred by the City for correction of cited violations, plus an additional 25% of this cost, to
cover administrative costs, will be charged to the owner.
Failure to correct violations may also result in criminal prosecution.
Code Compliance Division
78-495 Calle Tampico, La Duinta, CA 92247-1504
It is a misdemeanor to occupy this building or to remove or deface this notice.
Date: 8 ZG S Code Compliance Officer: -5AK 5 rV50^1
Phone: (
CODE 11.72 (7-04)