12-0628 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Nurnber:,_-_,-C- 0'00061 Owner:
A111�27�50 -28
MIL14E
Property Addres's': Cd-:ti,84,2
646-380-010- 48425 VIA SOLANA
Application description: REMODEL - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 13000
Applicant:
Architect -or Engineer:
Contractor:
-WHITLEY'S CONSTRUCTION
77775 JACKAL DRIVE
PALM DESERT, CA 92211
(-760)341-9480
Lic. No.: 805021
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 7771-7153
Date: 6/18/12
JUN 2) C. 2012 It
C ORPRTNTty Or= !.,A OUNIIA
— — — — — — — — — — — — ---- — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
LICENSED CONTRACTOR'S DECLARATION
— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — -- — — — — — —
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury r'
I am licensed under provisions of Chapte9 (commending with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of.the and Professionals Code, and my License is in full force and effect.
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
• License Class: B License No.: 805021
for by Section 3700 of Labor Code, for the performance of the work for which this permit is
f
issued.
Date: ea- Contractor:
I have and ill 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 License Law for the
Carrier QBE INSURANCE Policy Number EQB0200792
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 so 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 I should become subject to the workers' compensation provisions of Section
License Law (Chipter.9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3700 of the Labor Code, I shall forthwith comply with those provisions.
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 permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
Dater Applicant:
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 wh6does the work himself or herself through his or her own employees, provided that the
DOLLARS ($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, 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 contractor(s) 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 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 that t the ab v a information is correct. I agree to comply with all
a 'a
•n
work for which this permit is issued (Sec. 3097, Civ. C.).
I
city and county ordinances and state laws relating to . 0 .construction, and hereby authorize representatives
bu
;
of this county to enter upon the above-mentioned prope for inspection pur as.
Lender's Name:
Signature (Applicant or Agent):
'Lender's Address:
r6ate.4
LQPERMIT
Application.Number 12-00000628"
------ Structure Information 'INTERIOR REMODEL- REMOVE WALL/CLOSET
-----
Other struct info CODE EDITION
------------------------------------------------------------------
2010
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee '144.00 Plan Check Fee
93.60
Issue Date Valuation"
13000
Expiration Date 12/15/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
11.00 9.0000 THOU BLDG 2,001-25,000
99.00
_. --------------------------------------------
Special Notes and Comments
------------
INTERIOR REMODEL TO ENLARGE GREAT ROOM
BY REMOVING LOAD-BEARING WALLS AND
CLOSET [ENGINEERED] THIS PERMIT DOES NOT
INCLUDE ALTERATION -TO MECHANICAL,
.ELECTRICAL OR PLUMBING INSTALLATIONS.
2010 CALIFORNIA BUILDING CODES.
June 18, 2012 3:46:10 PM AORTEGA
---------------------------------------
Other Fees . . . . . . . ., BLDG STDS ADMIN (SB1473)
1.00•
STRONG MOTION (SMI) - RES
1.30
Fee summary Charged Paid 'Credited
Due
-- - - - - ------ - - - - ---
Permit Fee Total144.00 .00 .00
--- - - - - --
144.00
Plan Check Total 93.60 .00 .00
93.60
Other Fee Total 2.30 .00 .00
2.30
Grand Total 239.90 .00 .00
239.90
. LQPERMIT - -
Bin. #
Crty. of La Qurnta
Building &r Safety Division
P.O Box 1504, •78-495 Calle Tampico
fa.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
i
Project Addtrss: S Owner's Name:. ` 7–
A.
A P. NumberAddress: �7 r y
Legal Description: 'Q City, ST, Zip:
W.w,:.
Contractor. , �� Telephone:
Address: Z • -Project Description:
City, ST, Zip:
Telephone: ?4p —
M
State Lia # – City Lia #; .f�2
Arc6., fir', DesigneacBe%` ,
Address: %s yQ((s
City, ST. Zip: odl l�
Telephone: �6O Q —` Construction Type Occupancy:
State Lia #: k Project type (circle one): New Add'n Alter Repair Demo
- C
Name of Contact Person r '
,,. Sq. FL: #Stories: #Units:
Telephone # of Contact Person: 76 D . y dd Estimated Value of Proj
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Reed
TRAC MG
PERMIT FEES
Plan Sets
Plan Check submitted
��(p
Item Amount
Stmctuial Calm
2
Reviewed, ready for corrections
Plan .Check Deposit. .
Truss Calcs.
Called Contact Person
Plan Check Balance.
Mde.24 Cales.
Plana picked up
Construction
Flood plain plan
Plans resubmitted..
Mubariieal
Grading plan
2' Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
ML
H.O.A. Approval
Plans resubmitted
Grading
M HOUSE:-
''d Review, ready for correetio
Developer Impact Fee
Planning Approval
Called Contact Person 10 IV
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees