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BRES2016-0319LICENSED 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: BG License No.: 91533#DECLARATION Date: O Contractor OWNER-BUIL I hereby affirm under penalty of perjury t 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.). (1 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 aconstruction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Lender's (480)624-5200 Llc. No.: 915336 WORKER'S COMPENSAIION DECLARATION I hereby affirm under penalty of perjury one d the following declarations: I have and will maintain a certificat= of consent to self -insure for workers' compensation, as provided for by Section 3707 of the Labor Code, for the performance of t for which this permit is issued. I. and will maintain workers' cimpensation insurance, as required by Se io 700 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: TRAVELERS PROPERTY CASUALTY COMPANY. OF AMERICA Policy Number: YJUB282D7797 I certify that in the performance ofthe work for which this permit is issued, I shall not employ any person in any manner sc 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 Sect*3700ofabor Code, I shall forthwith comply with those provi�siioons�. Date: —[Applicant: WARNING: FAILURE TO SECURE WORKERN COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMIWAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,060). 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 :he 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 orcinances and state laws relating to building construction, and hereby authorize representatives of this city to enter Pon the above mentione property for inspection purposes. Date. Signature (Applicant or Agent): 4.4 a VOICE (760) 777-7125 78=495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT 3 8/2017 Application Number: BRES2016-0319 Owner: �� u Property Address: 53605 HUMBOLDT BLVD EAST OF MADISON APN: 767700020 P O BOX 1482 t� �¢ a Application Description: MADISON / MC CLURE / 8206 SQ FT LA QUINTA, CA 0 «� 3 a Property Zoning: pp C3 I Application Valuation: $884,237.70. ® U_ 9 Applicant: Contractor: _ z DISCOVERY BUILDERS DISCOVERY BUILDERS C CIO 80955 AVENUE 52 14605 N 73RD STREET rIF^� C'g, LA QUINTA, CA 92253 SCOTTSDALE, AZ 35260 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: BG License No.: 91533#DECLARATION Date: O Contractor OWNER-BUIL I hereby affirm under penalty of perjury t 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.). (1 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 aconstruction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Lender's (480)624-5200 Llc. No.: 915336 WORKER'S COMPENSAIION DECLARATION I hereby affirm under penalty of perjury one d the following declarations: I have and will maintain a certificat= of consent to self -insure for workers' compensation, as provided for by Section 3707 of the Labor Code, for the performance of t for which this permit is issued. I. and will maintain workers' cimpensation insurance, as required by Se io 700 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: TRAVELERS PROPERTY CASUALTY COMPANY. OF AMERICA Policy Number: YJUB282D7797 I certify that in the performance ofthe work for which this permit is issued, I shall not employ any person in any manner sc 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 Sect*3700ofabor Code, I shall forthwith comply with those provi�siioons�. Date: —[Applicant: WARNING: FAILURE TO SECURE WORKERN COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMIWAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,060). 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 :he 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 orcinances and state laws relating to building construction, and hereby authorize representatives of this city to enter Pon the above mentione property for inspection purposes. Date. Signature (Applicant or Agent): Date: 3/8/2017 Application Number: BRES2016-0319 Owner: Property Address: 53605 HUMBOLDT BLVD EAST OF MADISON APN: 767700020 P 0 BOX 1482 Application Description: MADISON / MC CLURE / 8206 SQ FT LA QUINTA, CA 0 Property Zoning: Application Valuation: $884,237.70 Applicant: Contractor: DISCOVERY BUILDERS . DISCOVERY BUILDERS CALIFORNIA INC DBA DB 80955 AVENUE 52 14605 N 73RD STREET. LA QUINTA, CA 92253 SCOTTSDALE, AZ B5260 (480)624-5200 ---------------------------------------------------------- Llc. No.: 915336 ----------------------------------- Detail: DEFERRED TRUSS SUBMITTAL FORM APPROVED 11/03/2016. SUBMITTAL AND APPROVAL OF TRUSS PACKAGE IS REQUIRED PRIOR TO ANY. INSPECTIONS. THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, DRIVEWAY APPROACH, BBQ FIRE PIT OR WL.TER FEATURE. HOME IS FIRE SPRINKLED PER 2013 CRC CODES FINANCIAL INFORMATION DESCRIPTION. ACCOUNT QTY AMOUNT ART IN PUBLIC PLACES - RESIDENTIAL 270-0000-43201 0 $1,710.59 Total Paid for ART IN PUBLIC PLACES - AIPP: $1,710.59 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $36.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $36.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - CIVIC CENTER 252-0000-43200 0 $942.00 DESCRIPTION ACCOUNT CITY AMOUNT DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 DESCRIPTION ACCOUNT CITY AMOUNT DIF - LIBRARIES 253-0000-43200 0 $344.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - PARKS/REC 251-0000-43200 0 $2,048.00 DESCRIPTION ACCOUNT CITY AMOUNT DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 DESCRIPTION ACCOUNT QTY AMOUNT TEMP POWER SERVICE 101-0000-42403 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT TEMP POWER SERVICE PC 101-0000-42606 0 $17.73 Total Paid for ELECTRICAL: $43.06 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $129.20 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, EA ADDITION 1,000SF, PC 101-0000-42600 0 $53.20 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $152.00 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL, FIRST 1,OOOSF, PC 101-0000-42600 0 $50.16. Total Paid for ELECTRICAL - NEW CONSTRUCTION: $384.56 DESCRIPTION ACCOUNT CITY AMOUNT RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT>7KSF 101-0000-42408 0 $38.00 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL PRECISE GRADING - CUSTOM HOME LOT >7KSF PCI 101-0000-42600 I 0 I $190.00 Total Paid for GRADING: $228.00 ' DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $228.00' DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $151.98 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 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE 101-0000-42402 0 $228.00 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE PC 101-0000-42600 0 $151.98.. DESCRIPTION ACCOUNT QTY AMOUNT . VENT FAN 101-0000-42402 0 $190.05 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $76.05 DESCRIPTION ACCOUNT QTY AMOUNT WALL HEATER 101-0000-42402 0 $75.99 DESCRIPTION ACCOUNT QTY AMOUNT WALL HEATER PC 101-0000-42600 0 $38.01 Total Paid for MECHANICAL: $1,157.80 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PERMIT 101-0000-42400 0 $1,013.67' Total Paid for NEW CONSTRUCTION PERMIT: $1,013.67 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,400.00 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $812.70 Total Paid for NEW CONSTRUCTION PLAN CHECK: $2,212.70 DESCRIPTION ACCOUNT QTY AMOUNT BACKFLOW DEVICE 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT BACKFLOW DEVICE PC 101-0000-42600 0 $5.07 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER PC 101-0000-42600 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $392.77 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $392:77 DESCRIPTION ACCOUNT QTY. AMOUNT GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $38:00 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT ROOF DRAIN 101-0000-42401 0 $152.04 DESCRIPTION ACCOUNT QTY AMOUNT ROOF DRAIN PC 101-0000-42600 0 $152.04 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $25.34 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $15:20 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: $1,261.91 DESCRIPTION ACCOUNT QTY AMOUNT SMI —RESIDENTIAL 101-0000-20308 0 $114.95 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $114.95 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 SINGLE FAMILY DETACHED 224-0000-20320 0 $1,837.44 Total Paid for TUMF - RESIDENTIAL: $1,837.44