BRES2017-019778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
4
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BRES2017-0197. .
80753 VIA SAVONA
777130005
TAHLER / PATIO REMODEL TO REMOVE CENTER COLUMN
$27,500.00
Applicant:
DAVID JACOBSEN DESIGN
49950 JEFFERSON ST #130-134
INDIO, CA 92201
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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.: 457228
Date: i ,% f Contractor
OWNER -BUILDER DECLARATION
I hereby Affirm under penalty of perjury that 1 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 that he or she is exempt therefrom and the basis for the
alleged exemption. Any violation of Section 7031.5 by any applicant fora permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( ) 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, 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'am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
1 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:
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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 Rion
k.for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
Se0 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9045509
_ 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 Code, I shall fo hwith
comply -with those provisions.
Date: Applicant:' o
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE AGE 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 isnot
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. O
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Date Anature (Applicant or Agent):
VOICE (760) 777-7125
0AV 77-7011
al INS
77-7153
i.i)
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oDate:
8/17/2017
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Owner: v
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TAKER M O
Cil
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625 NORTH HIGF&I" AVE!"
LOS ANGELES, CA&
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Contractor: —+
MONARCH HOM IDES
T`C?l:1S1 W BA DA.
49-950 JEFFERSON -IST #130-
13 '
INDIO, CA 92201
i
(760)413-8863
Llc. No.:457228
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 Rion
k.for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
Se0 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9045509
_ 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 Code, I shall fo hwith
comply -with those provisions.
Date: Applicant:' o
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVE AGE 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 isnot
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. O
Z :0
Date Anature (Applicant or Agent):
Date: 8/17/2017
Application Number: BRES2017-0197
Owner:.
Property Address: 80753 VIA'SAVONA
TAHLER
APN: 777130005.
625 NORTH HIGHLAND AVE. .
Application Description:. TAHLER / PATIO REMODEL TO REMOVE CENTER COLUMN
LOS ANGELES, CA 90036'
Property Zoning::
Application Valuation: $27,500.00
Applicant:.
Contractor.
'DAVID JACOBSEN. DESIGN "
MONARCH HOMES DESERT DIVISION`INC DBA DA" ".
49950' JEFFERSON ST #130-134
49-950`'1EFFERSON ST #130-134.
INDIO, CA 92201
INDIO, CA 9220E
(760)413-8863
llc. No.: 457228
Detail: PATIO REMODELTO REMOVE CENTER -COLUMN ONLY [ENGINEERED] THIS PERMIT DOES NOT INCLUDE ADDITIONAL SQUARE FOOTAGE OR
ELECTRICAL, MECHANICAL OR PLUMBING, ALTERATIONS. 2016 CALIFORNIA BUILDING CODE.
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A•WMAT•
z ;wDESCRI,PTI0N ACCOUNT
QTY AMOUNT
•BSAS SB1473 FEE 101-0000-20306
0 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, DESIGNED
'101-0000-42404
0
$139.84
DESCRIPTION'
ACCOUNT
QTY,
AMOUNT
PATIO COVER, DESIGNED PC
101-0000-42600
0
$176.32. .
Total Paid fo(PATIO COVER / COVERED PORCH / LATTICE: $316.16
DESCRIPTION
ACCOUNT
QTY
,AMOUNT
SMI - RESIDENTIAL
101-0000-20308.
0
$3.58.
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $3.58'
DESCRIPTION \
ACCOUNT
QTY
_AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
01
$5.00
Total Paidfor TECHNOLOGY ENHANCEMENT FEE: $5.00
•
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City
it Ouinta
Buffdfng 8L Safety Division
P.O. sok 1504,-78-495 Calle Tamplca
La.Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Mac a.o Z - o 114
FrmjectAddcess: 80753 Via Savona
owner's Name:. Mr..& Mrs. Tahler
A.P.Number. 777 3005.
Address: . 625 North Highland Ave.
Legal Description
city, st; zip: Los -Angeles 'C A 90036
Contractor: Monarch Homes Desert Div. Inc:
Telephone: 917-716-4280
Address: 49950Jefferson St. #130-134
Pto eq Description: Rehioving the center
city,sT,zikndio, CA 92201
column on an existing loggia.
Telephone--760-41378863, a '
State Lic. # 457228 city Lie. #;13511 ,
Atcfi., Engr., Designer g S'
gn
Address: 49950 J b fferson St. 4130-134
City, ST, Zip:Indio, CA 92201
Telephone: 760-413-8863 ConstructionTypm . occupancy:
State Lia #: • % Project type (circle one): New Add'n Alter Repair. Demo '
Name of Contact Person: David Jacobsen Sq.Ft.: #.Stories: #Units
Telephone # of Contact Pelson: 760-413-8863 Estimated Value of Project:
APPLICANT: D0. NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
- Rec'.d
TRACKING PERMIT FEES
Pian Sets
Plan Check submitted.
Item Amount
Strgctural Calcs.
Reviewed, ready for corrections
Plan Check Deposit...
IYtrss.Calcs.
Called Contact Person
Plan geek Balance"
Title 24 Calci.
Pians picked up
Construction
Flood plain plan
Plans resubmitted _' .
Mechanical
Gilding plan
2" Review, ready for correctiousliissue
Electrical
Subcoatactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval'Plass
resubmitted
Gradiag'
IN HOUSE.,
''" Review; ready for correetionslissue
Devdoper Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr '
Date of permit issue
School Fees
oto erni
t Fees