BRES2017-026078-495 CALLE TAMPICO D 64zill VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760)777-7153
BUILDING PERMIT
Date: • 11/14/2017
Permit Type/Subtype:
BUILDING RESIDENTIAL/REMODEL
Owner:
Application Number:
BRES2017-0260
GABRIEL ASCENCIO
Property Address:
52621 AVENIDA HERRERA
52621 AVENICA HERRERA
APN:
773293018
LA QUINTA, CA 92253
Application Description:
ASCENCIO RESIDENCE / REMODEL
Property Zoning:
Application Valuation:
$1,000.00
Applicant: Contractor:
JOAQUINA ASCENCIO D [rti OWNER BUILCER
52621 AVENIDA HERRERA
LA QUINTA, CA 92253 NOV 14 2017
CITYOFLAO. INTA Llc. No.:
COMMUNITY 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: % Contra
. OWNER -BUILDER DECLARATION
1 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
u Jects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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
r 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
LicenseLaw 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
C ntractors' State License Law.).
,f gam exempt under Sec. B.&#. for this reason
_r
CONSTR C1 N LENDING AGENCY
'I hereby affirm under penalty of pe ur that there is a construction lending agency for
the performance of the work for wh this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
WORKER'S COMPENSiATION'DECLARATION
I hereby affirm under penalty of perjury one :)f the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 37,30 of the Labor Code, for the performance
of the work for which this permit is issued.
_ 1 have and will maintain workers' s ompensation insurance, as required by
Section 3700 of the Labor Code, for the perfcrmance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carrie Policy Number:
1 certify that in the performance of the work for which this permit is issued, I
shall -not employ any person in any manner se) as to become subject to the workers'
compensation laws of California, and agree tia I should become subject to the
workers' compensation provisions of Section' 0 of the Labor Code, I shall forthwith
comply with those provisions.
Date: dApplicant: X
w"— �._ -
m
WARNING: FAILURE TO SECURE WORPERSICOMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TV CRM [NAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS 0,CO0). 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 tie Building Official for a permit subject to
the conditions and restrictions Yet forth on ttfs application.
1. Each person upon whose behalfthis applcation is made, each person at whose
request and for whose benefit work is perforeied 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 Cityof La Quinta, its officers, agents, and
employees for any act or omission related to -he work being performed under or
following issuance of this permit.
2. Any permit issued as.a result of this applii-ation becomes null and void if work is not
commenced within 180 days from date of isscance 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 aws relating to building
construction, and hereby authorize representatives of this ci o enter upon the above-
mentioned property for inspection purposes.
D : Id / V k1 ignature (Applicant_:�-r Age t)JJ
Date: 11/14/2017
Application Number: BRES2017-0260
Owner:
Property Address:. ° ' 52621 AVENIDA HERRERA
GABRIEL ASCENCIO
APN: 773293018
52621 AVENIDA HERRERA
Application Description: ASCENCIO RESIDENCE / REMODEL
LA QUINTA, CA 92253
Property Zoning: .
Application Valuation: $1,000.00
Applicant:
Contractor:
JOAQUINA ASCENCIO
OWNER BUILDER
52621 AVENIDA HERRERA
LA QUINTA, CA 92253
Llc. No.:
Detail: CODE COMPLIANCE CASE. GARAGE.CONVERSION THAT WAS NOT PERMITTED. NEW WINDOWS AND DOORS AND HVAC INSTALLED. GARAGE
SHALL NOT BE USED AS LIVING SPACE:
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
Credit Card Fee
101-0000-43505
0
$7.21
Total Paid for Credit Card Fee: $7.21
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0.
$26.01
Total Paid for ELECTRICAL: $52.02
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$0.50
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.50
DESCRIPTION
ACCOUNT
qTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0..'
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00.
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, EA ADDITION 1
101-0000-42400
0
$10.92
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, EA ADDITION 1 PC
101-0000-42600
0
$12.48
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1
101-0000-42400
0
$104.03
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1 PC
101-0000-42600
0
$118.59
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $246.02