11-0246 (RER)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA,-CALIFORNIA 92253 BUILDING &•SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
f ,BUILDING PERMIT
e - Date: 3/14/11
Application Number:" 11-00000246 ` Owner: +
Property Address:.. 57395 VIA VISTA;_ PIERCE KE=ITH
APN: •762-240-003-30' -300962-1 57395 VIA VISTA
Application description:. REMODEL - RESIDENTIAL LA QUINTA, CA 92253' +
Property Zoning: MEDIUM DENSITY RES (760) 578-7745
Application valuation 9000
+�' r i,"• -- x .Contractor:
Appli an : Architect or En ineer F' PADGETT' S CLEANI STO� I IE
535 NEW JERSEY S '"'^i 1 i 2011•
y' REDLANDS, CA -923 3- •
y rM (909)307-2769
- CITY QF !_A tdUlNTA
r679028r Fl�i�i�r��}I=PT.
_
- - - - - - - - - - - - - - - - - - - -'- - - - - - - - - - - - - - - - - .. - ....... .. -'- - - - - - - - - - - ^ - -
.f 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 following declarations:
Section 7000) of Division 3 of the Business_ 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 C15 -- 'Lice e'No.: '679028 • - - for by Section 3700 of the Labor Code, forthe performance of the work for which this permit is
issued. '
r. DateE4 ` - " Contractor. K _ _ _ .I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
_-. r QL
Code, for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLAR N .. _ - insurance carrier and policy number are:
c I hereby affirm under penalty of,perjury, that I am exempt from the Contractor's State license Law,for the. Carrier TRAVELERS PROP Policy Number DTJUB6155P03110
fotlouving reason (Sec. 7031.5, BusinessandProfessions Code: Any city or county that requires a permitao - - _- 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 s -person in any manner so as to becomesubject to workers' compensation laws of California, "
'.permit to file a signed statement that -heor she is licensed pursuant to the provisions Contractor's State and agree that, if I should 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 La r Code,1 shall forth i comp) 'th se provisio .:.
that he orshe is exempt therefrom and the basis for the alleged exemption. Any.violationof 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 D� - ate:-7`-r--`f-�•`-- Applicant:
I, as owner of theproperty,_ 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 ERS' COMPENSATION COVERAGE IS U FUL, 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 ($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
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 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, s
(" ) I am exempt under Sec. BAP.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 a
` - e performed under or following issuance of this permit. -
-Date: - - Owner:. 2. .Anµ 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 above 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 building construc ion, and hereby uthorize representatives -
of this fpugty to enter upon the above-mentioned roperty r inspecti n pur -
lender's Name: + /
- "'Date:~ Signature (Applicant or Agentl: r
Lender's Address:
.LQPERMIT - _ "
4 L
_ Application Number . . .11-00000246
r
Permit . . . ,BUILDING PERMIT`
-
t ' Additional desc
Permit Fee 108.00 Plan Check Fee
,
70 20k, a
,
Y' Issue Date' .. Valuation
9000
"
A. Expiration Date'. 9,/10/11
». •_
.
i Qty UnitCharge. Per r
Extension
•, BASE FEE ' ,-o.
, 45.00^ ;
7.00 _ 9:0000 THOU BLDG. 2,001-25,000
'4
" 63 00
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-- -- -- -- .. -
Permit ELECT'-ADD/ALT/REM
Additional desc
Permit Fee 15.75 Plan Check ,Fee
3' 94
Issue Date :Valuation '
0
r! Expiration Date ,. 9/10/11
i
~'Unit
Qty:. -Charge Per
Extension
k. , BASE" FEE
1.Or0 7500 PER ELEC DEVICE/FIXTURE 1ST*20„
? .75.
• --
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------------ - 7 ,. --- - -- -- - -- -
•
r ;Special Notes and Comments �
--- -
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T
, R
,.=,FIRE REPAIR DAMAGE, REPLACE WINDOWS (3) ; " • • � " w , . a.
^,t
'
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FIREDOOR; ELECTRICAL (5) FIXTURES AND
j, '- 'DRYWALL REPAIR. -APPROVED PER -APPROVED
- t
' c"t
PLANS & S. T s y' _- -3-- 7 R
- � t
P fA
- -- - -
-----Other
--1.00. --
Fees BLDG STDS ADMIN (SB1473)
'n
ENERGY REVIEW:`,FEE s
:7,.02
Fee summa arged�, Paid �'
Ch
ry, Credited
i-
Due' X;
�, --------- - -- -- - - --_- - - -- - - -- --- --' ---- -
F �^ _
' Permit Fee.,Total 123 •75 00 .00
°123.75-
t:
Plan.Check Total 74.14 0&: r
L't
1174.14
- .00
- Other -Fee Total -8.02 L 00 00
8.02 .-
' Grand Total- - 205.91 00 r 00
205.91.
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LQPERMIT
Bin #
City of La Qu'i#nt'a
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
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Project Address: ,3 5 V V
Owner's Name: �.
A. P. Number:
Address:
Legal Description:
Contractor: -
City, ST, Zip: Q C x cizz
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Address:
City, ST, Zi 73
..,
Project Description:. 1 '>C
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State Lic. #:V74 6-22 City Lic. #.I'M
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
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Construction Type: Occupancy:
State Lic. #'
.
Alter Repair Demo?v?',<.; Project tYPa circle one): New Add,n
Name of Contact Person;
Sq. Ft.:
# S ones:
# Units:
Telephone # of Contact Person:Qbq a
Estimated Value of Projec : c�
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
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 _
1
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2ad Review, ready for corrections/issue
Electrical i0
'
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
"d Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I,P,P,
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
t
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