12-0888 (RER)P.O. BOX 1504
78-495 C'ALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000888
Property Address: 50660 EISENHOWER DR APT 511
APN: 773-370-028-3 _000000 -
Application description: REMODEL RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 3500
Applicant: Architect or Engineer:
1,04Z4coaM=.
0_-
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
LANDS LP
3366 VIA LIDO SrD
NEWPORT BEACH, CA 92663
s
Contractor: '
GENERATION CONSTRUCTION 3
15650 EL PRADO
CHINO, CA 9170.8
(909)606�0370
Lia:. Nb.: 799464
VOICE (760) 777-7012
FAX (760) 777-70.1-1
INSPECTIONS (760) 7774153
Date: 6/08/12
AUG U 8 2012
CITY OF
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
( hereby affirm,under.penalty of perjury that I am licensed.under provisions of Chapter 9'(commencing with
,thereby affirmunderpenalty of perjury one of the,following declarations:
Section 7000) of Divis_ion3'of the Business and Professionis'Code, and my License is in full'force and'effect.
_ I have and will maintain &certificate oftoonse it to self -insure for workers' compensation, as provided
License Class: B- License No.: 199464
for by Section 3700 of„„the Labor Code;.for the performance of the. work for whichthis permit Is
dd
issued.
Date_: D 2 C_orrt_ractorc
_ 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
OWNER -BUILDER DECLARATION
insurance carrier and policy,number'are:
I hereby affirm. under' penalty of perjury that I arn:exempt from'the Contractor's-State,Lioense Law for the
Carrier COMPANION PROPT Policy Number CPCA13867
following reason (Sec. .7031 .5, Business`and Professions Code: Any, city or county that requires a permit,te
I
_ certify that, in the performance of the work forwhich this permit; Is issued, I"shall not employ any
construct, after, improve, demolish, or repair any structure, prior to haissuance,'also requires the applicant for the
person in any manner sous to become subject to the'workers' compensation laws of California,
permitto:file a signed statement that he or she ts,licensed pursuant to the,provisions of the.Contracior's State
and agree that, if I should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with. Section 7000) of Division 3 of the, Business and Professions Code) or •
3700 of the Labor Com} I shell.forthwith comply withithowprovisions.
that heorshe is exempt therefrom and the.basis`for the alleged exemption. ,Any violationof Section,7,031.5 by
w l%
"/
any.applicant for permit subjects the applicant to a civil penalty of novmore than five; hundred dollars ($500).:
bete: A/1�/''7 Applicant: faf- _ .
(_) 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, euslness:and Professions Code: The
ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,.AND SHALL
Contractors' State License Law does.not:apply to an owner of property who builds or'improves.there_on,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or heraslf:through his or herown employees, provided that the
DOLLARS of o0,0ool. IN ADDITION TO TH6COST OF COMPENSATION, DAMAGES AS PROVIDED'FOR IN
improvements -are not intended oroffered forsale. If, however, the building or improvement is sold within
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S,FEES.
one'year of ,completion, the owner -builder will have the burden of proving that hwor she,did not build or
Improve for the purpose; of sale:).
(_ 1 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, impm yes'thereon, and who contracts for the,projects with a cOntractor(s); licensed_
pursuant to the Contractors'' State License Law.).
1 _ 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 permitIsissued (Sec..3097, Civ. C.).
Lender's Name:,
Lender's Address:
LQPERMIT .
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 applicationds made„ each person st.whose request end;for
whose benefit work is performed under or pursuant.to any permit- issued as e,result of this application,
the owner, and the applicant, each+egress to, and shell 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, under or following issuance oYthls.permit.
2. Any permitissued as a result of this application becomes null and void If work.1s noucommenced
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 I have read this application and state that the above;information'is correct. I agree to'compiy with all
city and county,ordinances and state laws relating to building construction, and hereby authorize representatives
of this courly to enter upon the above-mentioned 'prope For inspection purposes.
D. 1 1Z Signature (Applicant or Agent):,
Application Number . . . . 12-00000888
------ Structure Information VEHICLE COLLISION REPAIR [CONVENTIONAL] -----
Other struct info . . . CODE.EDITION
---------------------------------------------------------------------------------
2010
Permit.. . . BUILDING PERMIT.
Additional desc .
Permit Fee . . 6.3.00 Plan Check Fee
4.0.95
Issue Date . . . Valuation . . .
. 3500
Expiration Date . . 2/04/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.0.0 9.0000 THOU BLDG 2,001-25,000
18.00
---------------------- -------------------------------------------------------
Special Notes and Comments
VEHICLE COLLISION REPAIR [CONVENTIONAL]
REPAIR TO STORAGE/ELECTRICAL. ROOM AND
INTERIOR UNIT AT KITCHEN - FRAMING,.
DRYWALL AND STUCCO. THIS PERMIT DOES NOT
INCLUDE ALTERATION TO THE EXISTING LOAD
PATH, OR ELECTRICAL, MECHANICAL OR
PLUMBING INSTALLATIONS. 2010.CALIFORNIA
BUILDING CODES.
August 8, 2012 3:03:25 PM'AORTEGA
-------------------------------
------------------.-.--------- .--------------------
Other Fees . . . . . BLDG STDS ADMIN (SB1473)
1-00
ENERGY REVIEW FEE
4-10
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited
Due
Permit Fee Total 63.00 .00 .00
63.00
Plan Check Total 40:95 .00 .00
40.95
Other Fee Total 5.60 .00 .00
5.60
Grand Total 109.55 .00 .00
109.55
LQPERMIT
City Of • La Qu!Ota
BuA ft ar Safety DMWon
P.O. Box 1504,-78-49S Calle Tampico
fa.Qdnta, CA 92255 -;(760) 777-7012
Permit Application and Tracking Sheet
Pemgtf
a.0990Building
ProieaxAd&W. -15-6--660 �=St.��c�
OwneesName:.
A P. Number 4 : n
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City, ST, Zip: ° L
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Contractor.6-c e r� ire.rv4- c.. L/10 n S Tr We —+ "M5
Telephone: % — Z3
Project Description
AAdr 5 �,s-� - �u� R �_
City, ST, Tap:
Telephonere-s
state Lia #: City Llc, k
al�
t�f- �aw.:� ct r., k s . OZ c 4
Ate., EW, Designw.
City. ST, zip. -
Telophone:
Steto,Lia #:
NameofContactPerson: g � ,5
stiaction Tj pe:. Occnpancy:
type (etude one): New Add'n Alter Repair Dem
Zq.
SFt,: # Storias # Uniw,
Telephone # of Contact Person:
EsdMatod Vahm of Project: 3 SD?� . OD
APPLICANT: DO NOT WWTE BELOW TIES LINE
M
Submittal
Req -d
Beed -
TRAC MG PERbIwrFEFS_
Phn Seb
Plan Cheek submitted Ibrm Amount
Stractard cdeg.
Bevkwe4 ready for cork ecttous 'Phu Check Deposit. .
Trans Cato.
Called Caataet Person Plaa Ckeek Balance _
Mile 24 Cake.
Puree pickcdup cantrucdoa
Flood pram plan
Plans revandow.. Mechanksl
Grading plan
2' Review, ready for correctionsruawe Electrical
SubcoutatOr List
CalledCoutattPerson Ph mblug
Grant Deed
Plautplcked up :Z.1 U
H:OJL Approval .-
Plans resabmltted Grading
IN HOMES
''' Beview, ready -for earectloosft" Developer ImpaetFee
n-uing Approval•
Caued coviset Pawn A.%P.P.
Pub. Wks. Appr -
Datt of ptrmft issue
School Fees
Total Permit. Fen