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78-495 CALLE TAMPICO �
VOICE (760) 777-7125
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LA QUINTA,.CALIFORNIA 92253
I hereby affirm under penalty of perjury one of the following declarations:
FAX (760) 777-7011.
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING.PERMIT
License Class: B License No.' 472150
of the work for which this permit is issued:
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r*nhave and will maintain workers' compensation insurance, as required by
Date: ..2/22/2017
Application Number: ' BRES2016-0323
Owner:
issued. My workers' compensation insurance carrier and policy number are:
Property Address: 48705. VIA SIERRA
A URQUHART
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APN: 658200015
P 0 BOX 340
shall not employ any person in any manner so as to become subject to the workers' '. .
Application Description:. URQUAHART RESIDENCE / REMODEL.
SOUTH PASADENA, CA 92253
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Property Zoning:
statement that he or she is licensed pursuant to the provisions of the Contractor's State
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Application Valuation:. $400,000.00
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alleged exemption. Any violation of Section 7031.5 by any applicant for a•permit
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subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS.UNLAWFUL,
(� 1, as owner of the property, or my employees with wages as their sole
Applicant'
Contractor:
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DESERT BUILDERS INC
DESERT BUILDERS INC
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71537 HIGHWAY 111.STE #A
71537 HIGHWAY 111 STE #A
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RANCHO MIRAGE, CA 92270
RANCHO MIRAGE, CA 92270
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the conditions and restrictions set forth on this application.
.(760)568-1793 .:
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construct the project. (Sec. 7044, Business and Professions.Code: The Contractors' State
request and for whose benefit work is performed under or pursuant to any permit issued
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as a result of this application, the owner, and the applicant, each agrees to, and shall
Llc. No.: 472150
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LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 •
I hereby affirm under penalty of perjury one of the following declarations:
{commencing with Section 7000) of Division 3 of the Business and Professions Code, and
I have and will maintain a certificate of consent.to self -insure for workers'
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.' 472150
of the work for which this permit is issued:
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r*nhave and will maintain workers' compensation insurance, as required by
Date: Y1 '� C66-:�
Section 700 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: BENCHMARK INSURANCE COMPANY Polity Number. CST5008047
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
_ I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers' '. .
city or county that requires a permit to construct, alter, improve, demolish, or repair any
compensation laws of California, and agree that, if I should become subject to the
structure, prior to its issuance, also requires the applicant for the permit to file a signed
workers' compensation provisions of Section 3700 of the Labor Code; I shall forthwith
statement that he or she is licensed pursuant to the provisions of the Contractor's State
comply wit those provisions.
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
Dat ?"'� rtApplicant l
alleged exemption. Any violation of Section 7031.5 by any applicant for a•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,
(� 1, 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 orherself through his or her own employees, provided that improvements
are not intended or offered for sale. If, however, the building or improvement is sold
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APPLICANT•ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that he
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
or she did not build or improve.for the purpose of sale.).
the conditions and restrictions set forth on this application.
(� I; as owner of the property, am exclusively contracting with licensed contractors.to
1. Each person upon whose behalf this application is made, each person at whose
construct the project. (Sec. 7044, Business and Professions.Code: The Contractors' State
request and for whose benefit work is performed under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon,
as a result of this application, the owner, and the applicant, each agrees to, and shall
and who contracts for the projects with a contractor(s) licensed. pursuant to the
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
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. 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
Date: Owner:
for 180 days will subject permit to cancellation.
CONSTRUCTION LENDING AGENCY
I certify that I have read this application and state that the above information is correct. ,
I hereby affirm under penalty of perjury that there is a construction lending agency for
I agree to comply with all city and county' ordinances and state laws relating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
construction, and hereby authorize representatives of this city to enter upon the above -
mention property for inspection purposes.
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('Dat'e: Z f Signature (Applicant or. Agent):
Lender's Address:
,
171 NANCIAL'IN FORMATION
DESCRIPTION ACCOUNT
QTY
AMOUNT
ADDITION, FIRST 100 SF 101-0000-42400
0
$127.68
DESCRIPTION ACCOUNT
QTY
AMOUNT
ADDITION, FIRST 100 SF PC 101-0000-42600
0
$179.36
Total Paid for ADDITION: $307.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PLAN CHECK/PERMIT EXTENSION PROCESSING
101-0000-42600
1
$101.84
Total Paid for ADMINISTRATIVE: $101.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - YES ADMINISTRATIVE STAFF
101-0000-42600
0.25
$10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER
101-0000-42600
2
$190.00
Total Paid for BLDG CITY STAFF - PER HOUR: $200.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$16.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $16.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, EA ADDITION 1,000SF
101-0000-42403
0
$25.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT -
RESIDENTIAL, EA ADDITION 1,000SF, PC
101-0000-42600
0
$10.64
DESCRIPTION
-ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$152.00
DESCRIPTION
ACCOUNT .
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$50.16
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $238.64
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCE REPAIR/ALTERATION
101-0000-42402
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCE REPAI R%ALTERATION PC
101-0000-42600
0
$5.07
DESCRIPTION
ACCOUNT
QTY
AMOUNT
EXHAUST HOOD
101-0000-42402
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
EXHAUST HOOD PC
101-0000-42600
0
$5.07
Total Paid for MECHANICAL: $35.48
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$12.67 ,
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT,
GAS SYSTEM, 1-4.OUTLETS
101-0000-42401
0
$12.67777J
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.67
DESCRIPTION
p ACCOUNT
QTY
AMOUNT'
WATER SYSTEM INST/ALT/REP PC
.101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: $88:68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101=0000=42400
.0.
$114.00
DESCRIPTION.
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
.$91:20
DESCRIPTION
ACCOUNT.
QTY
AMOUNT.
REMODEL, FIRST 100 SF
101-0000-42400
0 .
$51.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$14.1.36
Total Paid for REMODEL: $398:24
DESCRIPTION
...ACCOUNT
CITY.
AMOUNT
SMI : RESIDENTIAL
101-0000-20308
0
$52.00
o Total Paid for STRONG MOTION INSTRUMENTATION SMI: $52.00
-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,' RETRO/REPAIR, EA ADDITION 5
101-0000-42400.
0
$31.92
DESCRIPTION
-ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, RETRO/REPAIR, FIRST 7
10170000-42400
0
$63.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, RETRO/REPAIR, FIRST 7 PC
101-0000-42600
0
$62.32
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $158.08
TOTALS...