BRES2017-003478-495 CALLE TAMPICO D �iNII�C(/ VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/5/2017
Application Number: BRES2017-0034 Owner: -
Property Address: 79085 COYOTE CREEK ROB NORTHWOOD
APN: 776030025 79085 COYOTE CREEK
Application Description: NORTHWOOD / 110 Q . CLOSET ADD TIONT MAS- B M ' �DROOLA QUINTA, CA 92253
Property Zoning: ® ��
Application Valuation: $15,000.00
Applicant: JUN 05 2017 Contractor:
SOUTH WEST CONCEPTS, INC. DONLEY VAN MALSEN
78115 CALLE ESTADO, SUITE 105 49578 AVILA DR
LA QUINTA, CA 92253 cn-Y Or- LA QUINTA LA QUINTA, CA 92253
DESIGN AND DEVELOPMENT DEPART. -NT
(760)578-3889
Llc. No.: 1001901
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.: 1001901
Date: r0 / 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 Addre:
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.
_ 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:
Carrie : XEMPT Policy Number: _
I certify that in the performance of the 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 that ' should become subject to the
workers' compensation provisions of Section 00 o the mor Code, I shaIfowit
comply w��pplicant:
Date:
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 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 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 I s relating to building
construction, and hereby'authorize representatives of this ci to a ter upon the above
mentioned property for inspection purposes. �7 /
Date: 1 Signature (Applicant or Agent): AIX 141-4
Date: 6/5/2017
Application Number: BRES2017-0034 Owner:
Property Address: 79085 COYOTE CREEK ROB NORTHWOOD
APN: 776030025 79085 COYOTE CREEK
Application Description: NORTHWOOD / 110 SQ. FT. CLOSET ADDITION AT MASTER BEDROOM LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $15,000.00
Applicant: Contractor:
SOUTH WEST CONCEPTS, INC. DONLEY VAN MALSEN
78115 CALLE ESTADO, SUITE 105 49578 AVILA DR
LA QUINTA, CA 92253 LA QUINTA, CA 92253
(760)578-3889
Llc. No.: 1001901
Detail: NORTHWOOD / 110 S.F. ADDITION (CREATING 116 SF OF NEW CONDITIONED SPACE). ADD WALK-IN CLOSET AT MASTER BEDROOM + CREATE
NEW MECHANICAL CLOSET. RELOCATE EXISTING WATER HEATER AND FAU TO THE NEW MECHANICAL CLOSET. ADD LIGHTING AT CLOSETS AND
RELOCATE EXISTING CONDENSER TO NORTH END OF WEST SIDE YARD. 2016 CALIFORNIA BUILDING CODES.
FINANCIAL .• /,
DESCRIPTION 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 SF
101-0000-42400
0
$127.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ADDITION, FIRST 100 SF PC
101-0000-42600
0
$179.36
Total Paid for ADDITION: $390.64
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
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
QTY
AMOUNT
APPLIANCE REPAIR/ALTERATION
101-0000-42402
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCE REPAIR/ALTERATION PC
101-0000-42600
0
$5..07
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$25.33
Total Paid for MECHANICAL.: $81.07
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
Total Paid for PLUMBING FEES: $20.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$1.95
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.95
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00