BRES2017-0105T-4 O�iarw:
78-495 CALLE TAM PICIO D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Application Number: BRES2017-0105DU® Owner`
Property Address 80777 VIA SAVONA KENNETH LEWIS
APN: 777130007II `` 80777 VIA SAVONA
Application Description: LEWIS / (2) PERGOLAS, (1) DO R CHANGEOM B 17 YARD LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $65,000.00 CITVn
Applicant:
PINNACLE CUSTOM BUILDERS
PO BOX 7342
LA QUINTA, CA 92248
DESIGN AND DEIiELNTA
PMENIT DEPARTMENT
Contractor:
PINNACLE CUSTOM BUILDERS
PO BOX 7342
LA QUINTA, CA 92248
(760)898-2875
Llc. No.: 985547
Date: 7/12/2017
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code,
_ I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect.
compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: B License No.: 985547
of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
ate: ontractor
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:
OWNER -BUILDER DECLARATION
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9119959
1 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
I certify that in the performance of the work for which this permit is issued, I
city or county that requires a permit to construct, alter, improve, demolish, or repair
shall not employ any person in any manner so as to become subject to the workers'
any structure, prior to its issuance, also requires the applicant for the permit to file a
compensation laws of California, and agree that, if I should become subject to the
signed statement that he or she is licensed pursuant to the provisions of the
workers' compensation provisions of Section 3700 of the Labor Code; I shall forthwith
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
comply with those provisions.
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
ate: &icant:
permit subjects the applicant to a civil penalty of not more than five hundred dollars
.
($500).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
(_) I, as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
himself or herself through his or her own employees, provided that the improvements
are not intended or offered forsale. If, however, the building or improvement is sold
APPLICANT ACKNOWLEDGEMENT
within one year of`completion, the owner -builder will have the burden of proving that
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
he or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
(_) 1, as owner of the property, am exclusively contracting with licensed contractors
1. Each person upon whose behalf this application is made, each person at whose
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
request and for whose benefit work is performed under or pursuant to any permit
State License Law does not apply to an owner of property who builds or improves
issued as a result of this application , the owner, and the applicant, each agrees to, and
thereon, and who contracts for the projects With a contractor(s) licensed pursuant to
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
the Contractors' State License Law.).
employees for any act or omission related to the work being performed under or
(_) I am exempt under Sec. . B.&P.C. for this reason
following issuance of this permit.
`
2 An ermit issued'as a result of this a lication becomes null and void if work is
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:
Y p ve
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.
Q, te: %Z Si ature (Applicant or Agent):
Date: 7/12/2017 ,
Application Number:. , BRES2017-0105
Owner:
Property'Address: 80777 VIA SAVONA
KENNETH LEWIS
APN: ' .' - 777130007
80777 VIA SAVONA .
Application Description: LEWIS / (2) PERGOLAS, (1) DOOR CHANGEOUT & BBQ AT REAR YARD
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: ' $65,000.00
Applicant:
::Contractor.'
PINNACLE CUSTOM BUILDERS
PINNACLE CUSTOM BUILDERS
PO BOX 7342
PO BOX 7342 `
LA QUINTA, CA 92248. ,
LA QUINTA, CA 92248
(760)898-2875
Llc. No.: 985547
Detail: 178SF AND 76SF PERGOLAS, PATIO DOOR CHANGE OUT AT EXISTING WINDOW LOCATION AND BBQ AT REAR YARD [ENGINEERED].THIS PERMIT DOES
NOT INCLUDE LIGHTING AT PERGOLAS OR ADDITIONACCONDITIONED SQUARE FOOTAGE. 2016 CALIFORNIA BUILDING CODES.
t
FINANCIAL INIF611M., •
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0
$3.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $3.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
' DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
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 for PATIO COVER / COVERED PORCH / LATTICE: $316.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
'.$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
Total Paid for PLUMBING FEES: $38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$8.45
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $8.45
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1
101-0000-42400
0
$101.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1 PC
101-0000-42600
0
$115.52
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $216.85
Bin T7 4 6
ANµ Qt Of Lauh i to .
Guitding a Safety-Division !
Permit,l O' 78-495 Calle Tampico
v La Quinta, CA 92253 - (760) 777-701,2
Building Permit Application and Tracking Sheet
Project Address: Owner's Name:
A. P. Number:
Address: _ � J
Legal Description:
City, ST, Zip:Lo„ J Coe%, 2IS 3
Contractor: CJ<.•�
TelP
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Address: P-0. .g
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Project Description: i
City--ST' I-Zip.
17-ez4a
Telchnc
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State Lic. # :
City Lic. #;
�D.c47 ll.
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Arch., Engr., esi r: rte
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Address:
City, ST, Zip:.
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aneYon troch TYPeOecu
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State to Lic. #. •Pro•ect
type (circle one • New Add'n Alter Repair Demo
0J
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Perso .-7Jg;b
Estimated Value of Project-
rojec -APPLICANT:
APPLICANT:DO NOT WRITE BELOW THIS LINE
N
Submittal,
Req'd
Rcc'd
TRACIQNG
PERMITTEES '
Plan SelsPlan
Check submitted
Item
(Amount
Structural Calcs..
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs..
Called Contact Pcrson
Plan Check Balance.
'.
Title 24 Calcs.
/
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"d Review, ready for corrections/issue
\
Electrical
Subcont5ctorList
Called Contact Person '
Plumbing
Grant Deed
Plaris picked up
S.M.T.
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Reyiciv, ready for. corrections/issue
Developer' Impact Fee
Planning Approval
Called Contact Pei-son
A.I-P.P.
Pub. Wks. Appr
Dale of permit issue .
School Fees, .
1.
Total Permit Fees
,
i