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BPAT2017-0061r , 78-495 CALLE TAMPICO V LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BPAT2017-0061 Property Address: 54480 AVENIDA CARRANZA APN: 774243011 Application Description: SLICK RESIDENCE / PATIO COVER Property Zoning: 1 1 2 t Application.Valuation: $2,400.00 ' �• jr 2 col% Applicant: ice. A BERUMEN CONSTRUCTION 285 NORTH WOODLAND STREET BANNING, CA 92220 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.: 920968 Date:eO— Z l �� 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.). (_) 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: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/24/2017 Owner: SAM SLICK 54480 AVENIDA:CARRANZA LA QUINTA, CA 92253 Contractor: A BERUMEN CONSTRUCTION 28S NORTH WOODLAND STREET BANNING, CA 9220 (951)545-7352 Llc. No.: 920968 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certifica-e of consent to self -insure for workers' compensation, as provided for by Section 37C O 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 perfo mance of the work for which this permit is issued. My workers' compensation insuran:e carrier and policy number are: , Carrier: STATE COMPENSATION INSURANCE FJND Policy Number: 9115052 I certify that in the performance otthe work for which this permit is issued, I shall not employ any person in any manner sc 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 LaVode, I shall forthwith comply with those provisions. e picant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMIUAL 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 tl-e Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this appl[ation 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 actor omission related to tie 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'ssuance 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 ordi iances and state laws relating to building construction, and hereby authorize representatives of this city to enter u the above-mentioned property for inspection purposes. [)ate: D z ^ I ` Signaure (Applicant or Agent): 'Date: 8/24/2017. Application Number: BPAT2017-0061 Owner: Property Address: 54480 AVENIDA CARRANZA SAM SLICK APN: .774243011 54480 AVENIDA CARRANZA Application Description: SLICK RESIDENCE / PATIO COVER LA QUINTA, CA 92253 Property Zoning: Application Valuation: $2,400.00 Applicant' Contractor: A BERUMEN CONSTRUCTION A BERUMEN CONSTRUCTION 285 NORTH WOODLAND STREET 285 NORTH.WOODLAND STREET BANNING, CA 92220 BANNING, CA 92220 (951)545-7352 Llc. No.: 920965 Detail: r FINANCIAL .• 1. DESCRIPTION ACCOUNT CITY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $25.33 Total Paid for ELECTRICAL: $50.66 DESCRIPTION ACCOUNT CITY AMOUNT PATIO COVER, STD, OPEN 101-0000-42404 0 $101.84 DESCRIPTION ACCOUNT CITY AMOUNT PATIO COVER, STD, OPEN PC 101-0000-42600 0 $100.32 Total Paid for PATIO COVER / COVERED PORCH / LATTICE: $202.16 DESCRIPTION ACCOUNT CITY AMOUNT SMI —RESIDENTIAL 101•-0000-20308 0 $0.S0 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50 DESCRIPTION ACCOUNT CITY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 . $5.00 F Total Paid for TECHNOLOGY ENHANCEMENT FEE: . $5.00 • Blh, # /Pe'rrnit # Project Address: 6,qq, Qty of La Quinta Building &T Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet Z Owner's Name: A. P. Number: Address:5-qqv) AucWiPA-(!h94AWzA Legal Description: City, ST, Zip: Lh 41, (4 r I Contractor: ".C -d CO A15 7 If Telephone: . ......... ...... ................ Address: ress: 2 5- Al W M b LA-Alh Project Description: :so ijb Alu�-I-Ojiut-A-- City, ST, Zip: 6 Ala, o Q-0 v6 -R- 10 t Telephonc:q.6t-5qG- -7 State Lie. # 41 Z09 (a V City Lie. 7 -AL Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ig g Construction Type: Occupancy: State Lie. 4: Project type (circle one): Add'n Alter Repair Demo. Name of Contact Person: A4,h noc-U r,� Sq. Ft-: 1/0 # Stories: �Uni is: Telephone 9 of Contact Person: cl,'-571 6- q 9- 7 2, 'G Proj , L14�� Estimated Value of Projec 46 0 M. Submittal Req'd APPLICANT: DO NOT. WRITE BELOW THIS LINE Rcc1d TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural CaIcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance. Title 24 CaIcs. Plans picked up Construction. Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. 1I.O.A. Approval Plans resubmitted Grading IN ROUSE:- Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue SC11061 Fees, t Sy g0 AVCA #b4- PIP PU c6 'Q1 1D mo \110 �00 �A 'V` \S i \b tic.�' i :Foo L-- FCITY OF L.A�� LA BUILDING & SM APPRO 1 •GATE z� TE'M-E�� V E f. INTA DEPT. D 1 5s