BPAT2017-00604.
17$-495 CALLE TAMPICO
`SLA QUINTA, CALIFORNIA 92253
Application Number: BPAT2017-0060
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DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Property Address:
57141 MEDINAH
APN:
762110035
Application Description:
JUSTIS RESIDENCE / PATIO ADDITION 152 SF
Property Zoning:
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Application Valuation:
$10,000.00
Applicant:
GABRIEL RIOS
49901 CINNABAR
COACHELLA, CA 92236
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.: 684857
'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 ofthe 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).: .
(_) 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:
CONSTRUCTION LENDING 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 Name:
Lender's Address:
VOICE (760) 777-7125
FAX(760)777 -7011
INSPECTIONS (760) 777-7153
WORKER'S COMPENSA70N 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 3702 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 performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: ACE AMERICAN INSURANCE COMPAN- Policy Number: RWCC64339667
I certify that in the performance of the 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 X00 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 CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,00). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOB IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to tNe Building Official for a permit subject to
the conditions and restrictions set forth on this 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 tfoe 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 cancetation.
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 orcl lances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentiohed property for inspection purposes.
Date: Signature (Applicant or Agent):
aW 1/201
Owner:
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LARRY & NANCY. USTIS
57141 MEDINAH
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LA QUINTA, CA 92253
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Contractor: c�
BOB EDWARDS CDNSTRUCTIO ICORPQ EDV o
51-455 DESERT CUB DRIVE
LA QUINTA, CA 9.2253.
(760)777-8202
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Llc. No.: 684857
WORKER'S COMPENSA70N 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 3702 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 performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: ACE AMERICAN INSURANCE COMPAN- Policy Number: RWCC64339667
I certify that in the performance of the 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 X00 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 CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,00). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOB IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to tNe Building Official for a permit subject to
the conditions and restrictions set forth on this 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 tfoe 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 cancetation.
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 orcl lances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-mentiohed property for inspection purposes.
Date: Signature (Applicant or Agent):
Date: 8/31/2017
Application Number:
BPAT2017-0060
Owner:.
Property Address:
57141 MEDINAH
LARRY & NANCY LUSTIS
APN:
762110035
57141 MEDINAH
Application Description:
JUSTIS RESIDENCE / PATIO ADDITION 152 SF }
LA QUINTA, CA 9253
Property Zoning: .
Application Valuation:
$10,000.00
Applicant:
• I
Contractor.
GABRIEL RIOS
BOB EDWARDS CONSTRUCTION INCORPORATED
49901 CINNABAR
51-455 DESERT CLUB DRIVE
COACHELLA, CA 92236
LA QUINTA, CA 92253
(760)777-8202
LIc. No.: 684857
---------------------------------------------------------------------------------------------
Detail: 152 SF PATIO ADDITION. PER 2016 CALIFORNIA BUILDING CODE
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
HOURLY CHARGE - ESGIL STRUCTURAL ENGINEER
101-0000-42600 1 $120.00
Total Paid for BLDG CITY STAFF - PER HOUR: $120.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATIOM BSA: $1.00
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.
Total Paid for ELECTP.ICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, STD, OPEN
101-0000-42404
0
$101.84.
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, STD, OPEN PC
101-0000-42600
0
$100.32
Total Paid for PATIO COVER / COVERED PORCH /'LATTICE: $202.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$1.30
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.30
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
I
$5.00