12-0448 (DSF)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00000448
Property Address: 80092 VIA TESORO
APN: 772-250-018-3 -31349 -
Application description: DEMO - SINGLE FAMILY
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 29000
Tityl 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WILLIAM BAIN
80092 VIA TESORO
LA QUINTA, CA 92253
Contractor:
Applicant: Architect or Engineer:. DAVIS RESTORATION OF
77833 PALAPAS ROAD
#K11
PALM DESERT, CA 92211
(760) 360-1855
Lic. No.: 677877
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed un provisions of pter 9 (commencing with
Section 7000) of Division 3 of the Business and Prole Sion ode, dLic se is in full force and effect.
License Class: B se o:/:'7A77
Date:y �/7 Contractor:
OWNER -BUILDER DECLARATION
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 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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 _ 1 I, 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.(.
1 _ I 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.).
(_ 1 1 am exempt under Sec. , BAP.C. for this reason
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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/24/12
DL2 a
fT7APR425 2011
CITY OF LA QUINTA
FINANCE DEPT.
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 the work for which this permit is
issued.
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
insurance carrier and policy number are:
Carrier NATIONAL UNION Policy Number 910606
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 forthwith comply with those provisions.
-ZS t o JL % IA -1%1 S 1 31`—rN1�
Date: Applicant: L""
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 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 Director of Building and Safety 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 is 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 abov ormatio correct. I agree comply with all
city and county ordinances and state laws relating to buildin o cti to uth ze r presentatives
of this county to enter upon the above-mentioned prope inspect as
Date:�{ZS-/Z Signature (Applicant or Agent(:
Application Number . . . . . 12-00000448
Permit . . . DEMO PERMIT
Additional desc . .
Permit Fee . . . . 45.00 Plan Check
Fee
00
Issue Date . . . . Valuation
29000
Expiration Date . . 10/21/12
Qty Unit Charge Per
Extension
BASE FEE
45.00
----------------------------------------------------------------------------
Special Notes and Comments
DEMO FIRE DAMAGED ROOF/CEILING ASSEMBLY
ONLY TO MAKE SAFE ENTRY POSSIBLE FOR
INVESTIGATION. THIS PERMIT DOES NOT
INCLUDE DEMOLITION OF EXTERIOR WALLS.
PROPERTY SHALL BE SECURED TO PREVENT
ENTRY BY UNAUTHORIZED PERSONNEL.
April 24, 2012 3:39:28 PM AORTEGA
Fee summary Charged Paid Credited
----------------------=-----------------
Due
-----------------
Permit Fee Total 45.00 .00
.00
45.00
Plan Check Total .00 .00
.00
.00
Grand Total 45.00 .00
.00
45.00
LQPERMIT
Bin.#
C �. Crt�r �f LaWho
Bullding W Safety Division
v `� P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Steet
Permit #
Project Address. t�l'
Owner's Name:. W l L_6 7i�Ori IkY
A. P. Number.
Address: C)d Z %
A- fecmc)0
Legal Description:
City, ST, Zip: (_ j� L 1 2 2S—r]
Contractor:r'�`
��cl L l�'li l J�
Telephone: ;.�•�;.0 '
Address: T76
Project Description:
City, ST, Zip: C�} ZZ I
r'
Telephone:
P
Irl IIID S ST—
t7yjL.s
State Lic. # :
City Lie'. #; 87
Arch., Engr., Designer
Address:
7Jf L_ 1 fJ (/ . o f J4
City., ST, Zip:
Telephone:
-
State Lic. #: , rr� v
y'..:..'
Name of Contact Person:
-Constructanion Type: 0
2C� 1 i� � � cy:
Project type (circle one): New Add'n. Alter Repair Demo
Sq, Ft: 3 MC) # Stories:
J # Univ:
Telephone # of Contact Person:
Estimated Value of Project$ C)
APPLICANT: DO NOT WRITE BELOW THIS UNE
#
Submittal
Req'd
Recd
TRACKING
PERMrr FEES
Plan Sets
Plan Check submitted
em Amount
Structural Calm
Revlewed, ready for corrections
Plan Chcck De 3osit
Tr'ss Calcs•
Called Contact Person
Plan Check Ba_ance_
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Pians resubmitted
Mechanical
Grading plan
2`! Review, ready for correctiionsfissue
Electrical
Subcoutaetor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.XL
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Revlew, ready for coriectionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr -
Date of permit Issue
School Fees
Total Permit tees