BRES2017-003178-495 CALLE TAMPICO'.'
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
ANDRET WEBER
2276 VIA ALBA
PALM DESERT, CA 92260
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BRES2017-0031
50052 AVENIDA VISTA BONITA
658260054
SUPPELSA RESIDENCE / REMODEL + ADDITION
$100,000.00
SEP 01 2017
CITY OF A QUINTA
COMMUNITY DEVELDPMENTDEPARTMENT
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 Professions Code, and
my License is in full force and effect.
License Class: _ License No.:
Date: Contractor:
OWNER -BUILDER DECLARATION
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).:
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, as owner of the property, am exclusively contracting with licensed contractors to
r_ .
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.).
CAyI am exempt under Sec. B.&P.C, for this reason
�
i2-
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:
r
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760)-777-7153
Owner:
ROBERT SU?PELSA
50052 AVEPJIDA VISTA BONITA
LA QUINTA., ' 92253 .
Contractor:
OWNER BUILDER
Llc. No.:
Date: 9/1/2017
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a cerificate of consent to self -insure for workers'
compensation, as provided for by Sectio:i 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have.and will maintain work-ers' 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 inswance carrier and policy number are:
Carrier: Polity Number: _
'' ertify that in the performance of the work for which this permit is issued, I
sha I not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and ag -ee 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. f
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 ($7-00,000). 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 Building Official for 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 thisapplication 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:
n
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and count., ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purpmes. 7!_
Da ei 9�f�7 r -Signature (Apphca t or Agent): Z
Date: 9/1/2017
Application Number: BRES2017-0031 Owner:
Property Address: 50052 AVENIDA VISTA BONITA ROBERT SUPPELSA
APN: 658260054 50052 AVENIDA VISTA BONITA
Application Description: SUPPELSA RESIDENCE / REMODEL + ADDITION LA QUINTA" ' 92253
Property Zoning:
Application Valuation: $100,000.00
Applicant: Contractor:
ANDRET WEBER OWNER BUILDER
2276 VIA ALBA
PALM DESERT, CA 92260
Llc. No.:
Detail: 868 SF REMODEL OF KITCHEN, BAR, LAUNDRY, MASTER, GUEST BATH, AND POWDER ROOM, WITH 114 SF ADDITION TO GUEST BEDROOM 2
RELOCATE KITCHEN SINK, WATER HEATER, WASHER/DRYER, AND BATH FIXTURES. INCLUDES NO, ALTERATIONS TO KITCHEN, DINNING, OR LIVING
ROOMS. PER 2016 CALIFORNIA BUILDING CODE.
FINANCIAL
DESCRIPTION
•a•
ACCOUNT QTY AMOUNT
ADDITION; EA ADDITIONAL 500 SF
101-0000-42400 0 $65.36
DESCRIPTION
ACCOUNT QTY AMOUNT
ADDITION, EA ADDITIONAL 500 SF PC
101-0000-42600 0 $18.24
DESCRIPTION.
ACCOUNT QTY AMOUNT
ADDITION, FIRST 100 SF1
101-0000-42400 0 $127.68
DESCRIPTION
ACCOUNT QTY AMOUNT
ADDITION, FIRST 100 SF PC
101-0000-42600 0 $179.36
Total Paid fo-ADDITION: $390.64
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - ESGIL CIVIL ENGINEER
101-0000-42600
1.5
$157.50
Total Paid for BLDG CITY STAFF - PER HOUR: $157.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$4.00
Total Paid for BUILDING STANDARDS ADMINISTFATION BSA: $4.00
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: $202.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$63.35
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTUREITRAP PC
101-0000-42600
0.
$63.35
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.67
DESCRIPTION•
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$7.60
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12:67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: $210.31
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$45.60
DESCRIPTION
ACCOUNT
QTY
AMOUNT
' REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600.
0
$36.48
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
.$51.68
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-426000
$141.36
Total Paid for REMODEL: $275.12
DESCRIPTION
ACCOUNT
QTY
AMOUNT'
SMI - RESIDENTIAL
101-0000-20308
0
$13.00
Total Paid for STRONG MOTION, INSTRUMENZATION SMI: $13.00
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, NEW/ALT, FIRST 1
101-0000-42400
0
$101.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT; FIRST 1 PC
101-0000-42600
0
$115.52
Total.Paid.for WINDOW/SLIDING GLASS DOOR/FENT=STRATTON: $216.85