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BRES2017-014778-495 CALLE TAMPICO' U �NtiI11t1/ LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT' BUILDING PERMIT Application Number: BRES2017-0147 Property Address: 78495 COYOTE CANYON CT APN: 770240002, Application Description: GWALTNEY/REMODEL - ADD OQR ANDA ,LACE Property Zoning:14 2017 Application Valuation: $25,000.00 LD CITY OF LA QUINTA Applicant: DESIGN AND DEVELOPMENT DEPARTMENT GORDON STEIN 51053 SORREL COURT INDIO, CA 92201 . LICENSED CONTRACTOR'S DECLARATION . I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Cla License kTNo::LIC-01032 7 cDate: y rCont�acto�: OWNER -BUILDER DECLA ATION 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 riot 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 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 contractors) licensed pursuant to the Contractors' State License Law.). (_) I am exempt under Sec. &P.Q. for this reason i P _— CONSTRUCTI NG 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 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/14/2017 Owner: RICHARD DURHAM 5772 HOLLADAY BLV SALT LAKE CITY, LT 92253 Contractor: ENGSTROM CONSTR MANAGEMENT OUTSIDE CITY LIMITS LA QUINTA, CA 92253 (760)668-3960 Llc. No.::LIC-010U16 WORKER'S COMPENSATDON DECLARATION I hereby affirm under penalty of perjury one ofthe 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' coFi pensation 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: _ Policy Number: _ I certify that in the performance of tie work for which this permit is issued,'I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree tha:, if I should become subject to the workers' compensation provisions of Section 3=00 of the Labor Code, I sh orthwith comply wi tho rovisions. Date Applicant: WARNING: AILURE TO SECURE WORKERS' COh1PEN TION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,00Q. 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 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 th,e 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 sta-e that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building constructi n, and h reby authorize representat,wes of thi it to enter upon the above- ioned p ope ty for inspection purposes. Date: Signature,(Applicant cr Agent) L7 v •,r Date: 8/14/2017 Application Number: BRES2017-0147 Owner: Property Address: 78495 COYOTE CANYON CT RICHARD DURHAM APN: 770240002 5772 HOLLADAY BLV Application Description: GWALTNEY / REMODEL - ADD DOORS AND FIREPLACE SALT LAKE CITY, UT 92253 Property Zoning: Application Valuation: $25,000.00 Applicant: Contractor: GORDON STEIN ENGSTROM CONSTR MANAGEMENT 51053 SORREL COURT OUTSIDE CITY LIMITS INDIO, CA 92201 LA QUINTA, CA 92253 (760)668-3960 Llc. No.: :LIC -0103216 Detail: INTERIOR REMODEL. ENLARGE EXISTING OPENINGS AT REAR EXTERIOR WALL TO ACCOMODATE (3) NEW STACKING DOORS INTO COVERED LIVING . AREA. REPLACE EXISTING FIREPLACE AT LIVING ROOM WITH DIRECT VENT FIREPLACE. THIS PERMIT DOES NOT INCLUDE NEW SWITCHING OR LIGHTING AT NEW DOORS, NOR DOES IT INCLUDE ANY INTERIOR ALTERATIONS TO OTHER SPACES OF THE HOME. 2016 CALIFORNIA BUILDING CODES. Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $126.16 FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES ADMINISTRATIVE STAFF 101-0000-42600 3.25 $10.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES ADMINISTRATIVE STAFF 101-0000-42600 3.25 $10.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER 101-0000-42600 1 $95.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER 101-0000-42600 1 $95.00 Total Paid for BLDG CITY STAFF - PER FOUR: $210.00 DESCRIPTION ACCOUNT QTY 1 AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT. FIREPLACE 101-0000-42400 '0 $152.00 DESCRIPTION ACCOUNT QTY AMOUNT FIREPLACE PC 101-0000-42600 0 $228.00 Total Paid for FIREPq ACE: $380.00 DESCRIPTION ACCOUNT QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $3.25 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $3.25 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMEN— FEE: $5.00 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW; RETRO/REPAIR, FIRST 7 101-0000-42400 0 $63.84 DESCRIPTION ACCOUNT QTY AMOUNT DOOR/WINDOW, RETRO/REPAIR, FIRST 7 PC 101-0000-42600 0 $62.32 Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $126.16