BRES2017-0182LICENSED 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.: 601890.
Date:9�4
,00;0�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).:
(_1 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:
WORKER'S COMPENSATON 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 370C of the Labor Code, for the performance
of tl �k �for which this permit is issued.
t*
� 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9051227
_ I certify that in the performance of ;he 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, if I should become subject to the
workers' compensation provisions of Section 390Labor Cod hall forthwith
comply with those provisions.
Dat` e: l Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL,
AND SHALL SUBJECT AN.EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,00➢). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOP 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 thi_: application.
1. Each person upon whose behalf this appli: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 owns, 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 cance7ation.
CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct.
I hereby affirm under penalty of perjury that there is a construction lending agency for . I agree to comply with all city and county ordiiances and statelaw relating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives of this city r upon the
above-mentioned property for inspection purposes.
Lender's Name: R
oat 2 Signature (Applicantor Agent): -�
Lender's Address:
..�O.�i
VOICE (760) 777-7125
78-495 CALL ETAMPICO
D�
FAX
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGNN &D
& D
DEVELOPMENT DEPARTMENT
(760) 777-7153
BUILDING PERMIT
v
D eL /2017
Application Number: BRES2017-0182
Owner: Z
Property Address: 48217 CALLE FLORISTAS
LYNN VOU TEMPSKY n D
APN: 646092009
78217 CALLE FLORISTASI C
Application Description: TEMPSKY / 6 S:F. ADDITION + REMODEL
LA QUINTA, CA 922S3mc O 6'
Property Zoning:
r__ -n W
Application Valuation: $150,000.00
5 Q
N
rn C p
Applicant:
Contractor: Q -�
C D L CONSTRUCTION INC
C D L CONSTRUCTION IN%
PO BOX 92
PO BOX 92tlo
THOUSAND PALMS, CA -92276
THOUSAND PALMS, CA 92276
(760)343-5101
Llc. No.: 601890
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.: 601890.
Date:9�4
,00;0�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).:
(_1 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:
WORKER'S COMPENSATON 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 370C of the Labor Code, for the performance
of tl �k �for which this permit is issued.
t*
� 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9051227
_ I certify that in the performance of ;he 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, if I should become subject to the
workers' compensation provisions of Section 390Labor Cod hall forthwith
comply with those provisions.
Dat` e: l Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL,
AND SHALL SUBJECT AN.EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,00➢). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOP 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 thi_: application.
1. Each person upon whose behalf this appli: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 owns, 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 cance7ation.
CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct.
I hereby affirm under penalty of perjury that there is a construction lending agency for . I agree to comply with all city and county ordiiances and statelaw relating to building
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize representatives of this city r upon the
above-mentioned property for inspection purposes.
Lender's Name: R
oat 2 Signature (Applicantor Agent): -�
Lender's Address:
.''
Application Number: ,8RE52017-0182
Property Address: 48217 CALLETLORISTAS
APN: 646092009
Application Description: TEMPSKY / 6 S.F. ADDITION + REMODEL
Property Zoning:
Application Valuation: $150,000.00
Owner:
LYNN VOU TEMPSKY
78217 CALLE FLOFISTAS
LA QUINTA, CA 92253
Date: 8/23/2017
Applicant:. Contractor:
C D L CONSTRUCTION INC C D L CONSTRUCTON INC
PO BOX 92 PO BOX 92
THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276
(760)343-5101
Llc. No.: 601890
-------------------------------------------------------------------------------------------=-
Detail: TEMPSKY /ADDITION + REMODEL. ADD 6 S.F. AT BREAKFAST/DINING ROOM (NEW`fOTAL LIVABLE AREA OF 2,074 S.F.). REPLACE ALL WINDOWS
THROUGHOUT HOUSE. REMOVE AND REPLACE KITCHEN LIGHTING, RECEPTACLES, AND APPLIANCES. RELOCATE INTERIOF PARTITIONS AND INSTALL STEAM
SAUNA AT MASTER BATH. NEW SHOWERS AND TUB AT BATHROOMS. [ENGINEERED DESIGN] 2016 CALIFORNIA BUILDING CODES.
I
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
HOURLY CHARGE - CITY BUILDING STAFF
101-0000-42600 0.5 $76.00
Total Paid for BLDG CITY STAFF - PER HOUR: $76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$6.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $6.00
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
DESCRIPTION
ACCOUNT
QTY
AMOUNT
OTHER ELECTRICAL EQUIPMENT
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
OTHER ELECTRICAL EQUIPMENT PC
101-0000-42600
0
$25.33
Total Paid for ELECTF:ICAL: $101.32
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$38.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$38.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: $101.36
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$91.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$72.96
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: $357.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT ..
SMI - RESIDENTIAL
101-0000-20308
0
$19.50
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $19.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin #
City of La Quina -
Building 82; Safety Division
78-495 Calle Tampico
La Quinta, CA 92253.- (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
go
:P.ro` ject Address: l O s E
70: n is Name: y �j( ��(f
A. P. Number:
eddress: C �� O VAS
J
Legal Description:
`ty, ST, Zip:&A WGt-r+ C+
Cno tractor:
f c� G c
1 �%
��
-e lehn•
o e.
.Address: dSrp 5' 6111-. S �t%r Qy
Zp o ct Description:
Ciry, ST, Zip: (Y4 %
c�
r .ep -one-
T h
e1 _
7 3 3
� (O f
Stt'ate Lic. # : a
City Lic.
Arch., Engr., Designer:
Address:
a
leity�ST, Zip:
,,,Telephone:
A<>
Construction TYP e: Occupancy:
cY:
l
State Lic. #
Project typeci
(circle one): New Add'n t Repair Demo
C—_"Sq
Namf f Contact Person:ER
Ft: ' oQ
# Stories:
# Units:
,Telephone # of Contact Person: ?60—,3,75' 3 3
-E; matW Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIUNG
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss talcs.
Called Contact Person
Plan Check Balance
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissue
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
Total Permit.Fees
Date: 8/22/2017
No.: 17-00700-1
Owner: Lynn Vou Tempsky
Address: 48-217 Calle Floristas
City: La Quinta, CA
Type: Residential Addition < 500 sq ft
CERTIFICATE OF COMPLIANCE
Desert Sands Unified School District
47950 Dune Palms Road
La Quinta, CA 92253
(760)771-8515
Lot # Street No. Street Name
48-217 Calle Floristas
Comments:
tXWEO
Q yCir�lf,�y0
to BERMUDA DUNES
RANCHO MIRAGE
~�
PALM DESERT y
%0 COACHELLA a
LAOUINTA 7�
QIN
OIO y
Email:
Jurisdiction: La Quinta
Tract #:
Sq. Feet APN Permit No.
6 646-092-009
RE CEIVED
AUG2 2.2017
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions
under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking eating, or sanitation) or replacement
mobile homes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
Exempt
This certifies that school facility fess imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 6 S.F. or $0.00 have been paid for the property listed above and that building permits
and/or Certificates of Occupancy for this square footage in the proposed project may now be issued.
Fees Paid By: Exempt\Chris Lehuede Check No.:
Bank Name/Recipient of Certificate Telephone: 760-275-3133
Funding: Exempt
By . Scott L. Ba i I ey
Superintendent
Fee Collected/ Exempted by: Virgilio Garcia \ ` Certificate Fees D'ue: "$0.00
Original Payment(s)-Recd: ;$0.00 %
1 New Paymen4 Recd: -$0':00
Over�/;Under: x$0:00 2"_
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify r"'' v
y yo that the 90 -day approval period in which you may, prot-st,the,fees or,
other payment identified above will begin to run from the date on which the building installation permit for this project is issued, or from `the_'date on
which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier.
Notice to Building Department: THIS DOCUMENT VALID ONLY IF IMPRINTED WITH EMBOSSED SEAL.
Building Permit Number.
Project Description: small remodel
.Exempt: 0
(Materials may contain. hazardous wastes and
are not subject to recycling provisions)
Construction Debris Management Plan
Plan Submittal Dotal 8/18/2017
Job Site Address 48217 Calle Flodstas (Laguna de la Paz)
Owner's Name
Number, Street, or PO Box
City, State, Postal Code
Owners Phone Number
Owners E -Mail Address
Lynn Von Tempsky
6 Puu Hale St
Lahaina, HI. 98761
808-887-6139
Project Managers Nampl Christian Lehuede
Project Managers Phone Number 760-275-3133
NeckMonagets, E-mallAddrsss CDLconstructionfdtearthlink.net
Builder / Contn
Number, Street or PO
CRY, State, Postal C
Project Square
City Approval By
Date of City Approval
To Be Discarde
Product
Trash
Asphalt
Brick/Block
Cardboard
Commingled
Concrete
Drywall
Donated / Reuse*
*Describe Items
CDL Construction
P.O. Box 92
Thousand Palms, CA. 92276
Approx. 2,026 square feet
Renedo Gouldlock-OECBuntec Waste
1.75 Not recyclable
0.00 Recyclable
0.00 Recyclable
0.00 Recyclable
0.00 Recyclable
Totals: Recycle Trash
3.3 1 1.8
Product
Tons
Masonry (broken)
0.(
Plaster
0.(
Scrap Metal
0.(
Tile (floor)
0:
Tile (roof)
0.(
Wood
2.(
Landscape Debris
0.(
Projected Diversion:
65.27
I understand it is the property owner's responsibility to submit copies of weight tickets or receipts to the District
Environmental Coordinator as these hauls occur. I hereby certify that completion, implementation and adherence of the
Debris Management Plan (DMP) for the above named project shall guarantee that at least 65% of the jobsite waste is
diverted from landfilling. The remaining material will be recycled or reused. i will divert, for recycling or re -use, remaining
materials generated from the first day of the project through the completion of the project in accordance with this plan. This
DMP is Issued in the name of the property owner(s) and shall remain their property throughout the construction and/or
demolition project A contractor serving as agent of the owner may obtain a DMP for the owner. However, the DMP is still
issued in the name of the property owner(s) and the owner retains legal responsibility for ensuring that the provisions of the
DMP are adhered to. The property owner(s) and general contractor shall be kept informed of the diversion progress through
bi-monthly reports. If self -hauling, all refuse material from this project site must be taken to an approved recycler or transfer
Owner / Developer / Project Manager / Superintandant Date