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11-0137 (RER)4- R.O. BOX 1504. 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253. BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number:11-=000001373 Property Address: C79962 VIENTO DR APN: 609-630-033- - - Application description: REMODEL - RESIDENTIAL 'Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 10000 Applicant: Architect or Engineer: ---------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION - I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professio als Code, and my License is in full force and effect. License Class: B license o.: 926128 =Date-) '1 ' 11 ��Contractor: OWNER-BUILDERIECLARATION I 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).: ( _) 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 puipose of sale.). (_ 1 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 I am exempt under Sec. , B.&P.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 Owner: HUMPHREY DAVID V/JAMIE M . 79962 VIENTO DR. LA QUINTA, CA 92253 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/17/11 Contractor: �! U=17 u DANTOR MARTINEZ CONSTRL� T81057 AVENIDA ROMERO INDIO, CA 92201. ` (760) 702-6209 t CITY OF LA QUINTA Lic. No.: 926128 4 e?!v�r;-EWEPT. ------------------ 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. 1 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 EXEMPT Policy Number EXEMPT' I certify that, in the performance of the work for which this permit is issued, -I shall not employ any person in Zany manner so as to become subject to the workers' compensation laws of California, and agree that, if I should be me su ject to the workers' compensation provisions of Section 3700 of the Lahhr Code, 1 sh I fortith comp with those provisions. Date: ^11��'.Applican WARNING: FAILURE TO SEC U KERS' COMPENSAT N 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 above information is correct. I agree to comply with.all city and county ordinances and state laws relating to building construction, d hereby authorize re esentatives of this county to enter upon the above-mentioned prope y for inspection pu oses. Date: 4� Signature (Applicant or Agentl: Application Number 11-00000137 ------ Structure Information .MASTER -BATHROOM REMODEL ----- Other struct info CODE EDITION 2010 Permit . . . BUILDING PERMIT Additional desc . Permit.Fee 117.00:.• Plan Check Fee 76.05 Issue•Date Valuation . . ... 10000 Expiration Date 8/10/11 Qty Unit Charge Per Extension BASE FEE 45.00 8.00 9.0000 THOU BLDG 2,001-25,000 ------------------------------------------------------------------------------ 72.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee 15.75 Plan Check_ Fee 3.94 Issue Date . . . . Valuation_ . . . . 0 Expiration Date 8/10/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 .7500 PER` ELEC DEVICE/FIXTURE 1ST 20 .75 Permit . . . PLUMBING Additional-desc . Permit.Fee . . . . 21.00 Plan Check Fee 5.25 -Issue Date . . . . Valuation . . . 0 ' Expiration Date 8/10/11 Qty Unit Charge Per-. Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6,00 Special Notes and Comments REMOVE TUB AND ENLARGE SHOWER.AT MASTER BATHROOM - INCLUDES REPLACING CABINETRY AND RELOCATION OF ELECTRICAL LIGHTING AND RECEPTACLES. 2010 CALIFORNIA BUILDING CODES. February 11, 2011 2:19:36 PM AORTEGA ------------------------------------ -------------- ------------------- other Fees BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 7.61 Fee summary Charged Paid Credited Due LQPERMIT _ .... - .. .. ' Application Number .. 11-00000137 - Permit Fee Total 153.75 .00 .00 153.75 Plan Check Total 85.24 00 .00 85.24- Other Fee Total 8.61 .00 .00 8.61 ' Grand Total 247.60 :00 .00 247.60 " • LQPERMIT .' .. _. Bin # Qty of La Quinta Building Br Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 9225.3 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit #/A Project Address: Owner's Name: D(A\/t A. P. Number: Address: 19- 9 611- Vitf*V TR. Legal Description: City, ST, Zip: 11� Git rH-rA C! Contractor:'D)I-V�X 141 U� �WGI� 10 tj M� Telephone: Address: NZ6�d k Project Description: City, ST, Zip: InAlo I C -K oou)l 'Deft W\ 17�* U6 ne i Telephone: 1 D1- (PWj 15h6wel.'— INODd WOO(-, State Lic.#: LIU00100 City Lica ff. Arch., Engr., Designer:9 C MIVS Yd1fA NIW I Gk 2k M Address:(tibw6c6u)dq-K a City., ST, Zip: Telephone: Construction Type: Occupancy: State Lic. #: - Project type (circle one New Add'n ter Repair Demo Name of Contact Person: Sq. Ft.:. # Stori es; # Units: Telephone # of Contact Person: I U() Estimated Value of Project: 000 .00 APPLICANT: DO NOT $RITE BELOW THIS LINE H Submittal Req'd RecldJrx V r..;j TACKING -3 PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural CaIcs.V-L A F1 U15 'lull Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance. Woft Tide 24 Cales. Plans picked up 4construction Ir vs Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrcctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for correctionslissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit Issue 16J- Offt OF W School Fees OL Total Permit Fees Ov*# V0 -- VAPA towg-: i;,