BRES2017-00064 _ ,
78-495 CALLE TAMPICO D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BRES2017-0006
Property Address: 44090 CAMINO AZUL
APN: 604180010
Application Description: PALERMO / DRYWALL REPAIR 96 SQ FT
Property Zoning:
Application Valuation: $1,000.00
Applicant:
MIGZ GENERAL CONTRACTING
31-330 AVENIDA MARAVILLA
CATHEDRAL CITY, CA 92234
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: B License No.: 983810
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).:
(_) 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.). ,
(� 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.).
(_J 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
Lender's Address:
(760)668-0003
Lic. No.: 983810
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of'he 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: VEMPT Policy Number: _
' Lce` tify that in the performance of the work for which this permit is issued, I
s I 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 3770 of the Labor Code, I shall forthwith
comply with those provisions.
Dat 3 Applicant:—
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 N SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official 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 Cty 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 applica-iori 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, and hereby authorize representati+es of this city to enter upon the
above
—mmentioned property for inspection purposes.'
Date: Signature (Applicant o Agent)
C.�
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIO 60) 777-7153
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Owner:
d
STEVEN PALERMO
® r` IFQ- Q
Z
92253
M aLU
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Z O LL
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Contractor:
Z
MIGZ GENERAL CONTRA
31-330 AVE NIDA MARA
LL® Z
CATHEDRAL CITY, C -A 92
4 W
(760)668-0003
Lic. No.: 983810
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of'he 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: VEMPT Policy Number: _
' Lce` tify that in the performance of the work for which this permit is issued, I
s I 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 3770 of the Labor Code, I shall forthwith
comply with those provisions.
Dat 3 Applicant:—
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 N SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official 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 Cty 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 applica-iori 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, and hereby authorize representati+es of this city to enter upon the
above
—mmentioned property for inspection purposes.'
Date: Signature (Applicant o Agent)
C.�
r
Date: 1/13/2017
Application Number: BRES2017-0006
Owner:
Property Address: 44090 CAMINO AZUL
STEVEN PALERMO
APN: 604180010
Application Description: PALERMO / DRYWALL REPAIR 96 SQ FT
92253
Property Zoning:
Application Valuation: $1,000.00
Applicant:
Contractor:
MIGZ GENERAL CONTRACTING
MIGZ GENERAL CC NTRACTING
31-330 AVENIDA MARAVILLA
31-330 AVENIDA MARAVILLA
CATHEDRAL CITY,.CA 92234
CATHEDRAL CITY, CA 92234
(760)668-0003
-----------------------------------'----------------------------------------------------------
LIC. No.: 983810
Detail: 96SQ FT OF DRYWALL REPAIR IN GARAGE. 2016 CALIFORNIA BUILDING CODES.
r
DESCRIPTION .
ACCOUNT
•D.TY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION. BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
$51.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT .
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$141.36
Total Paid for REMODEL: $193.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
Total Paid for STRONG MOTION INSTRUMENTATION.SMI: $0.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TGrALS: $199.54
Iain
Qty of La Quinto
BuildinD &I Safety Division
Permit #{ 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-701,2
COP Building Permit Application and Tracking ShEet
Project Address: I/y0 Fo NC ' LOwner's Name e- :
A. P. Number:
Address: 7 Q 0.r1vt A -Z4 11
Legal Description:
City; ST, Zip: [,` / 22-,53
ntra
Co ct r:
o r C
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Tele hon 0
Address:3 .
Project Description:
City, ST, Zip:
Telephone:' -o
0 - 00
AA IQ.O X• T
P O .F
P
State Lit. # :
City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
cu an
Occupancy:
cY
�Con tructi n TYPe:
State Lic - #-
Repair DemoAdd n plterPr Project circle one • New
Name of Contact Person: ��
�Z
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person:76.0.
6 000 �?
Estimated Value of Project: �1 a d G �'�v
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes,
Revicwed, ready for corrections
Plan Check Deposit
Truss C21eS.
Called Contact Person
Plan Check Balance .
Title 24 Cales.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Revietiv, ready for corrections/issue
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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks- Appr
Date of permit issue
School Fees,
1
Total Permit Feo
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