11-0022 (RER)P.O. BOX 1504 VOICE (760) 7774012
78-495 CALLE TAMPICO FAX (760) 777-7011.
'LA.QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT`, INSPECTIONS (760) 777-7153 ,
BUILDING PERMIT
Dater 1/06/11
Application. Number: ��=11
00.0-00022 '' Owner:
Property Address: 78435 VIA SEVILLA 'LARSON AMY
APN: 60.4-212-004•-60 -23971.- 78435 VIA SEVILLE
' Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 9225
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: . 1800
Contractor:
Applicant: Architect or Engineer. DAVIS RESTORATION OF P
�� 77833 PALAPASROA �o r-
PALM DESERT, 2
(760)360-.1855
„y ,r
- - _ - Lic . No, : 677877_ •n �//�/�� .
'LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION. DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with - I hereby affirm under penalty of perjury one of the follow ing*declarations: -
Section 7000) of Division 3 of the Busin ss nd Professionals Code, and my License is in full force and effect. _ I have and willmaintaina certificate of consent to self-insure for workers' compensation, as provided
License Class: B Liz se o.: 677877 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
/ .r - .. issued. - _ -
.' Date: / D6 �t� Contractor. - _ 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 am exempt from the Contractor's State LicenseCaw for the Carrier EMPLOYEE SRVC Policy Number 2246
'.following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to - _ I certify that, in the performance of the work for Which this permit is issued, I shall not employ any .,
construct, alter, improve, demolish, or repair any structure, prior to its issuance,'also requires the applicant for the - person in any manner o as to become subject to the workers' compensation laws of California,
.permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State - • and agree that, if 1 s d 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 C de I shall thwi co ply with those provisions. '
that he or she is exempt.therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 1 FF -
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (55001.: Date: ' J-Q6:;Wf Applicant:l
1 — 1 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 WARNING: 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 thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the.work himself or herself through his or her own employees, provided that the DOLLARS 1$100,000). IN ADDITION TO THE COST OF'COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.). - APPLICANT ACKNOWLEDGEMENT "
1_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. - IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractods) licensed 1 . Each person upon whose behalf this application is made, each person at whose request and for
-pursuant to the Contractors' State License Law.).. , .whose benefit work is performed under or pursuant to any permit issued as a result of this application, -
`
I—) I am exempt under Sec. - , B.&P.C. for this reason 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. - -
Date: Owner: - - 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
CONSTRUCTION LENDING AGENCY permit to cancellation. -
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the ove information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). - city and county ordinances and state laws relating to buil ing construn, and hereby authorize representatives
of this county to enter upon the above-mentioned pr pe y f insp ti put ses.
Lender's Name: - --.
}Date: Signature (Applicant or AgentL
• Lender's Address:
Application Number 11-00000022'
Permit . .. BUILDING PERMIT
Additional desc .
Permit Fee . . . 41.00. Plan Check
Fee
26.65
Issue Date Valuation
1800
. Expiration Date'. 7/05/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
13.00 2.0000 HND .BLDG 501-2,0-00
26.00.
Special Notes .and Comments
STUCCO REPAIR BE-LOW_UPSTAIRS SLIDER/
WATER IS COMING IN THE AREA OF THE -
SLIDER AND COMING OUT DOWNSTAIRS ABOVE
THE LIVING ROOM SLIDER. APPROVED PER.
B.H.
--------------------------------------------------------
Other Fees. . . . . . BLDG STDS ADMIN (SB1473)
1.00
'ENERGY REVIEW FEE
2.67
Fee summary Charged Paid* Credited
Due .
Permit Fee Total 41.00 .00
.00
41.00
Plan Check•Total 26.65 .00,
.00
26.65
Other Fee Total 3.67 .00
.00
3.67
Grand Total •71..32 .00
.00
71.32
LQPER IIT - ..
d
S
Bin #
City of La Quinta
Building & Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Pen'nit #
Project Address: : _ C J3 2
Owner's Name: / 'lD vl_
A. P. Number: �G C�-
Address:
Legal DescriptiorX
City, ST, Zip: L ,� -�-a C cjaa�3
Contractor: a, ,< < s
Telephone:NINE € f> a '
Address: 3 3 ala s r�
Project Description:
City, ST, Zip: "all wr- G
iQas &,C -
Telephone: ?coD -3,610-J gs� i' ..:. •; "' V � �•;'�^'�
%2. d' �D�v-r of � tzu rf o
State Lie. #
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone: ,»
State Lie. #:
:Name of Contact Person: C
Construction Type: l�SicK�i a� Occupancy:
Project type (circle one): New Add'n Alter epair emo
Sq. Ft.: 7 poaD
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:..41?00
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
2od 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 HOUSE:-
30 Review, ready for correcdonsAssue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees