BRES2016-0370�t;:. ter—. �+ � • J
-78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
JOSE LOPEZ
52920 EISENHOWER DR
LA QUINTA, CA 92253
BRES2016-0370
52920 EISENHOWER
773331010
LOPEZ RESIDENCE/ EI�10�
$45,000.00
Tit,�p 4 4 Qum& -
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
�o DJAN 20 2017
CITY OF LA QUINTA
DESIGN AND DEVELOPMENT DEPARTMENT
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
fec.P7044,
asowner of the property, or my employees with wages as their sole
nsation, will do the work, and the structure is not intended or offered for sale.
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
jhRshe dd not build or improve for the purpose of sale.).
, as owner of the property, am exclusively contracting with licensed contractors
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
t ntractors' State License Law.).
I am exempt under Sec. B.&P.C. for this reason
Date: 1 Za1-7 <pner:
CONSTRUCTIOrOENDING 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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760)777-7153
Date: - 1/20/2017
Owner:
JOSE LOPEZ
52920 EISENHOWER DR
LA QUINTA, CA 92?53
Contractor:
OWNER / BUILDER
Lic. No.:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificateof 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 perfornance 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 t=ie work for which this permit is issued, I
shall not employ any person in any manner so :,s 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 3-00 of the Labor Code, I shall forthwith
comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINI4L 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 ownee, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the =ity of La Quinta, its officers, agents, and
employees for any act or omission related to tl• a 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 cancel ation.
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 representacives of this city to enter upon the
above-mentioned property for inspection purposes.
Si a re (Applicant or Agent): 4&_ aA
'
Date: 1/20/2017
Application Number:
BRES2016-0370
Owner:
Property Address:
52920 EISENHOWER DR
JOSE LOPEZ
APN:
773331010
52920 EISENHOW,=R DR
Application Description:
LOPEZ RESIDENCE/ REMODEL
LA QUINTA, CA 92 @53
Property Zoning:
Application Valuation:
$45,000.00
Applicant:
Contractor:
JOSE LOPEZ
OWNER / BUILDER
52920 EISENHOWER DR
LA QUINTA, CA 92253
----------------------------------------------------------------------------------------------
Llc. No.:
Detail: KITCHEN REMODEL. NEW TILE, SHOWER IN THE MASTER BEDROOM, MOVING LAUNDRY
TO GARAGE, RELOCATING KITCHEN CABINETS, AND
REMOVING NON BEARING WALLS. PER 2013 CALIFORNIA BUILDING CODE,
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS S81473 FEE
101-0000-20306
0 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
CITY
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
EXHAUST HOOD
101-0000-42402
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
EXHAUST HOOD PC
101-0000-42600
0.
$5.07
Total Paid for MECHANICAL: $17.74
DESCRIPTION
ACCOUNT
CTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
10
$38.01
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$38.01
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: $101.36
DESCRIPTION
ACCOUNT
CTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
D
$22.80
DESCRIPTION
ACCOUNT
CTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$18.24
DESCRIPTION
ACCOUNT
CTY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
3
$51.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
)
$141.36
Total Paid for REMODEL: $234.08
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
)
$5.85
Total Paid for STRONG MOTION INSTRUMENTATION _' MI: $5.85
DESCRIPTION
ACCOUNT,
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00