13-1269 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4tyl
��
VOICE (760) 777-7012
FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number: 13-00001269
Property Address: 52045 EISENHOWER DR
APN: 773-225-013-2 -000000-
Application description: REMODEL - RESIDENTIAL
Property Zoning: COVE RESIDENTIAL
Application valuation: 5500
Applicant: Architect or Engineer:
-----------------
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 Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: Contractor:
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 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
th a or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
plicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($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 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.).
j I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
✓✓✓lll 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
\iny�1(/pursuant to the Contractors' State License Law.).
1 1 am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY L
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
Owner: D
HURWORTH LLC
77186 CASA DEL SOL
LA QUINTA, CA 9225
Contractor:
Owner
OCT 2 9 2013
CITY OF LA QUINfA-
10/29/13
-----------------------------------------------
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 fVPolicy Number
rtify 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 shou come spject to the workers' compensation provisions of Section
3700 of the Labor e, I hall forthwith comply with those provisions.
Date: ✓ Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 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 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.
1 certify that I have read this' application and state that ovei.formatio is correct. I agree to comply with all
city and county ordinances and state laws relating uilding.construction, and hereby authorize representatives
of this cou ty enter upon the above-mentioned rop y r inspection purposes.
Date: I C3 Signature (Applicant or Agent):
Application Number . . . . . 13-00001269
------ Structure Information WINDOW CHANGE/CARPORT CONV/BLOCK WALL -----
Other struct info . . . . . CODE EDITION 2010
----------------------------------------------------------------------------
Permit . .
Additional desc .
Permit Fee
Issue Date . . .
Expiration Date .
REMODEL 2013
131.56
4/27/14
Plan Check Fee . . .00
Valuation . . . . 0
Qty Unit Charge Per Extension
1.00 71.5000 EA MISC PARTITION 71.50
1.00 60.0600 LS MISC DR/WIN, REPL, 1-7 60.06
-----------------------------------------------------------------------------
Permit . . .
Additional desc . .
Permit Fee .
Issue Date . . . .
Expiration Date . .
ELECTRICAL 2013
23.83
4/27/14
Plan Check Fee .00
Valuation . . . . 0
Qty Unit Charge Per Extension
1.00 23.8300 LS ELEC DEVICES, FIRST 20 23.83
-------------------------------------------------- --------------------------
Permit . . . WALL/FENCE PERMIT 2013
Additional desc .
Permit Fee . . . . 47.19 Plan Check Fee .00
Issue Date . . . . Valuation 5500
Expiration Date . . 4/27/14
Qty Unit Charge Per - Extension
1.00 47.1900 LS MISC WALL, FIRST 100 LF 47.19
----------------------------------------------------------------------------
Special Notes and Comments.
FRENCH DOOR CHANGE OUT AT EXISTING
WINDOW OPENING, CARPORT CONVERSION TO
GARAGE AND 60LF OF FIVE AND SIX FOOT
HIGH BLOCK WALL AT FRONT YARD [ORCO
SPECIFICATION/CONVENTIONAL LIGHT -FRAME
CONSTRUCTION] THIS PERMIT DOES NOT
INCLUDE MECHANICAL OR PLUMBING
ALTERATIONS OR REMODEL TO OTHER AREAS OF
THE DWELLING NOT NOTED. 2010 CALIFORNIA
BUILDING CODES.
October 14, 2013 3:10:29 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
LQPERMIT
Application Number . . . . . 13-00001269
----------------------------------------------------------------------------
Other Fees . . . . . . . . . PLAN CHECK,.ELECTRICAL 23.83
PLAN CHECK, REMODEL• 240.24
PLAN CHECK, WALLS 60.06
STRONG MOTION (SMI) - RES .55
Fee summary Charged Paid Credited Due
Permit Fee Total 202.58 .00 .00 202.58
Plan Check Total .00 .00 .00 .00
Other Fee Total 325.68 .00 .00 325.68
Grand Total 528.26 .00 .00 528.26
LQPERMIT
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: i5F Owner's Name: QW0R::t tALL-C—
A. P. Number: Address: -7-71& CAM DEC SCX—
Legal Description: City, ST, Zip: �'k(JZj1
Contractor: C <::#:»:>:?<:>::<>;.,.;;>:<.;s: S(�Gll Telephone: � S -0 <> .
Address: �G %� k f r&4 t (,)(A LA- C09§-A Project Description: '2�� I cmc% YAgz)
City, ST, Zip: WYLLQlk CA C):;IS6�;LAt)-,
Telephone: >:f;;<:>..
� 0-371 ::: o
State Lic. #: 3 City Lic. N.-..4::Rsf—bcc-C7 j/�/ �CJ�1,
Arch., Engr., Designer: •vjFAQ. Cir Ci+ke-keiYZ *«A
Address:) -FA l vp OF
City, ST, Zip:
Telephone: :::•>• •>:;::•;:.::. Construction Type: Occupancy:
.::i:<i:•:;rii:j.iiiii ;:iii:"{':::.;ii:� i �:ii i•:•:'f:::
n Alter Repair DemoSto a Lic. #:
Project hPa circle one): New Add 1
Name of Contact Person: M K . - t R i Sq. Ft.: # Stories:(')h(� # Units:
Telephone #,of Contact Person: �`—� Estimated Value of Project: "^
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
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
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.1.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrccticdsg tA
Developer Impact Fee
Planning Approval
Called Contact Person
P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
U ..�.
---P O."Vk ,E' so KU. -B W 1 t4*4. t14""a-
J
r
,r
A
U
�0
' t �.
CONSTRUCTION HOURS
October 1st - April 30
Monday - Friday: 7:00 a.m. to 5:30 p.m. � S
Saturday: 8:00 a.m. to 5:00 p.m.
Sunday: None
Government"Code Holidays: None
May 1st - September 30th
Monday - Friday: 6:00 a.m. to 7:00 p.m.
Saturday: 8:00 a.m. to 5:00 p.m.
Sunday: None
Government Code Holidays: None
n
�a
f
at F&4
CITY O LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE
BY
W Mi0001 it V"IL ISS- WAIA-0
606g
x`sr,c
auc)c4 VS
CITY
OF LAO
I
ITA
BUlWI
_U SAFE -Y
DEPT
APROS
FOR
ONSTRU
TI
N
DATE
BY
DATE
BY
l�
ciw
00
0 �+
/NSUIL 6V4r,6A'L/NE W/Ty —
VALVE AOR FUTU.QE 5f�1t/NKLET
60n/7;?OL .
W CALLE SONORA
0Z)
9
df
1L.
11
CALLE DURANGO
C
m
CITY OF LA QUINTA'SUB-CONTRACTOR LIST
JOB ADDRESS PERMIT NUMBER OWNER ER. --BUILDER.
This form shall be posted on the Job with the Building Inspection *Cardat all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job.. Any -changes to this list 'Must be approved by the Building Division prior to commencement of work. Failure to comply will re . sult in a stoppage of work and/or the voidance
of building permit. i -or each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade I Classification
"Contractor,'
`A
'-";-state-- Contra.cto- ... r,s-� uqn- S-1
r 6hije:
CityZd stooss License
Company Name
Classification
(e.g. A, B, C -8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp, Date
(xxlxx/xx)
EARTHWORK (C712)
CONCRETE (C;_8),:-_
FRAMING -.0;
.2-
MASONRY -(C-29)
139
PLUMBING (C -36j
LATH: PLASTER (tr3r)) —
C�l
DRYWALL (C-9)
HVAC. (C720)":
ELECTRICAL (C=10)
ROOFING
. ET
SHE vt
FLOORING !91_0.�'15)....
GLAZING (C-1 7)'::
INSULATIONJC72)
6--421-
SEWAGE DISPi.. (G-421' '
PAINTING
PAINTING (C'33)'-:
7.
CERAMIC TILE (C-54)
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C=27)--.-..-:.
A.
, , " " , - , - _`_: I'.
POOL (C-53)
P.O.'Box 1504
LA QUINTA,* CALIFORNIA 92247-1504
78-495 CALLE TAMPICO
LA QUINTA,,CAt.AFORNIA,92253
BUILDING &'SAFETY DEPARTMENT
(760) 777-7012
-FAX (760) 777-70,11
P -D r%
ROPERTYOWNEWS PACKAGE
Disclosures & Formis for Owner -.Ru . Uders Applying for . r Cdnsttuction Permits
00LRS' NV. NOTICE TO FROPM-Ty-ownpt
Dear Property Owner.
Aii. application -for -a building permit -has bwn, submitted in your name lis yo as builder of the.prop�
improvements spocified at r_—__t5r;,4KCxJ0Z --,-a, _Q1
We are providing you with an Owner -Builder Acknowledgment -and information-Vefification Form to make you aware of your�
respowibiliftes and possible risk you may incur by having this permit .issued lin'yourname as the -
Owner -Builder. We will not issue,a building -permit until -you -have -read, initialedyottirunderstad of each'tnvvision,
signed, and returned this form to us at our official address . indicated. An agent of the�owner cannot execute this -notice
unless you the property owner, obtain the prior approval of the permitting authority.
Read and &aW- each sta6eiient 6daw to sign 6 you urderstcurd 0-r
1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder"
buTidling.permit that cmWou* -implies that the property owner is providing his or her own labor and materia. . I personally. 1, as
an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained byan unlicensed person
and his or her employees While working on my property. My homeowner's insurance may not provide coverage for those
injuries. I am wiUMY acting as an Owner -Builder and am aware of the limits of my insurance -coverage for injuries to workers
'CProperty. Y
p`()pe
2.11 understand building permits are not required to be signed by property owner's unless they are responsible for the
traction and ate'. not hiring a licensed.,Contractor to assume this re"rssibility_
3. lunderstand as an."Own.er-Builder"l.,am the tisponsible party of.reclordon the permit-Junderstand That may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his'or fiir name instead of my
174. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license numbers on
its and contracts.
W5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value
of my construction is at least five hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
6- 1 understand if I am considered an -e mployer"under state and federal Iaw, register with the state and federal
I must . gis
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." -1 also understand -my failure to- abide by these laws may subject me to serious financial
k ris
7. 1 understand under California Contractors' State. License Law, an Owner -Builder who builds single-family residential
stru �
stru ures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed
' subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract with A licensed general building Contractor.
iz
I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be heli liable,for any
financial or personal. injuries sustained by any subsequent owner(s) that result from any latent construction defects in the
w,pylcmanship or materials.
W-9. I understand I may obtain more information regarding my obligations as an "employee' from the Interaal Revenue
Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CS -B) at 1-
.. �800- 21-CSLB (2752) or www.csib.ca.gov for more information about licensed contractors.'
0. I - - - - . d understand that I am the
1 am aware of and consent to an Owner -Budder building permit applied for in my name, an
p legally and financially responsible for- proposed constru" ac vi at the following address:
L I agree that, as the party legally and financially responsible for this proposed construction activity, .I will abide by all
able laws and requirements that govern Owner -Builders as well as employers.
I agree to notify the issuer of this form immediately of any additions; deletions, or changes to any of the information i
have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you Contract with
.someone who does, not have a license,. the Contractors' State License Board may be unable to with &I loss
you may sustain as a result of a complaint Your only remedy against unlicensed Contractors may be in civil.court- It is also
important for you to: understand that if an unlicensed Contractor or employee of that individual or firm is injured while wOddng
on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors,
you will be .responsiMe forr verifying whe wr or not those Contractors are properly licensed and the status of .their woekem'
compensation insurance coverage.
Before a building permit can be issued, ties form must be completed and signed by the property owner and returned to
the agency responsible for issuint&e. ermit. Note. A copy of dw property owner's driver'sAwase, farm nen; or
other verification acceptablere at gens ".uired to be presented "en the permit is issued to verify the property
owner's signature.
Signature of property owner Date:
Note: The following Authorization Form is required to be completed by the property owner only when designating
an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACTON PROPERTY OWNER'S BEHA[�F
Excluding the Notice to Property Owner, the execution of which I understand. is my personal responsibility, I hereby authorize
the following persons) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder
Permit for my project
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Tel No
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
information and certify its accuracy. Note: 'A copy of the owner's driver's license, form notarization, or other verification
acceptable to the agency is required'to bepresented when thepermit is issued to verify the property owner's signature.
Property Owner's Signature: Date: