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