BRES2017-0309,C41.
78-495 CALLE TAMPICa"_
LA QUINTALALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
CHRIS SCULLEY
49813 AVENIDA MONTERO
LA QUINTA, CA 92253
DESIGN & DEVELOPMENT. DEPARTMENT
BUILDING PERMIT
BUILDING RESIDENTIAL/REMODEL
BRES2017-0309
49813 AVENIDA MONTERO
646192047
GIFFIS/INTERIOR REMODEL WITH FENESTRATION CHANGEOUT
$100,000.00
pQ 0
NOV 29 2017
'CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
VOICE (.760) 777-7125
• fAX (760) 777-7011.
INSPECTIONS (760) 777-7153
Owner:
FOREST GIFFIN
49813 AVENIDA MONTERO
LA QUINTA , C: 92253
Contractor:
OWNER BUILDER
Llc. No.: 1,
Date: 11/29/2017
- - - - - - - - - - - -.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -.- - - - - - - - - - - - - - - - - - - - - - -
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:
Contractor:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations: '
I have and will maintain a certific.te of consent to self -insure for workers'
compensation, as provided for by Section 3T70 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 perfc rmance of the work for which this permit is
issued. My workers' compensation insuranc-e carrier and policy number are:
OWNER -BUILDER DECLARATION
Carrier: _ Policy Number: _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
_ I certify that in the performance o-. the work for which this permit is issued, l
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner s.:) as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair any
compensation laws of California, and agree that, if I should become subject to the
structure, prior to its issuance, also requires the applicant for.the permit to file a signed
workers' compensation provisions of Sectiona700 of the Labor Code, I shall forthwith
statement that he or.she is licensed pursuant to the provisions of the Contractor's State
comply with those provisions.
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
Date: Applicant:
alleged exemption. Any violation of Section 7031.5 by any applicant for a permit
suJiijeps the applicant to a civil penalty of not more than five hundred dollars ($500).:
WARNING: FAILURE TO SECURE:WORKERS' C1]MPENSATION COVERAGE IS UNLAWFUL,
as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIM INAL PENALTIES AND CIVIL FINES UP TO
compensation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
within one year of completion; the owner -builder will have the burden of proving that he I IMPORTANT: Application is hereby made to tie Building Official for a permit subject to
or did not build or improve for the purpose of sale.). the conditions and restrictions set forth on the application.
W1, as owner of the property, am exclusively contracting with licensed contractors to 1. Each person upon whose behalf this appl cation is made, each person at whose
construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State request and for whose benefit work is perforned under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon, as a result of this application , the owner, andithe applicant, each agrees to, and shall
and who contracts for the projects with a contractor(s) licensed pursuant to the defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
Cgnj;sactors' State License Lew.). employees for any act or omission 'related to The work being performed under or
I am exempt under Sec. : B.&P.C. for this reason 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 issLance of such permit, or cessation of work
Date: IZ?V2Owner: for 180 days will subject permit to cancellation.
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
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 laws relating to building
construction, and hereby authorize representEtives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: ~� iL;; Signature (Applicant -or Agent):
i
�' •
Date: 11/29/2017
:e
Application Number: BRES2017-0309
Owner:
PropettyFAddress--',;. ' °49813 AVENIDA MONTERO
FOREST GIFFIN
APN: 646192047
49813 AVENICA MONTERO
Application Description: GIFFIS / INTERIOR REMODEL WITH FENESTRATION CHANGEOUT
LA QUINTA, CA 92253
- Property Zoning:
Application Valuation: $100,000.00
Applicant:
Contractor:
CHRIS SCULLEY
OWNER BUILDER
49813 AVENIDA MONTERO
LA QUINTA, CA 92253
--------------------------------------------------------------------------------------------
Llc. No.:
Detail: INTERIOR REMODEL AT BATH 1 & 2 ANO KITCHEN, CHANGEOUT OF FENESTRATION SURFACES
AT MASTER 1:AND LIVING, AND NEW LIGHTING -
THROUGHOUT [CONVENTIONAL] THIS PERMIT DOES NOT INCLUDE CHANGEOUT OF MECHANICAL OR PLUMBING APPLIANCES. 2016 CALIFORNIA
BUILDING CODES
i
DESCRIPTION
ACCOUNTQTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $4.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $4.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, EA ADDITION 1,000SF
101-0000-42403
0
$26.52
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL; EA ADDITION 1,000SF, PC
101-0000-42600
0
$10.92
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$156.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RESIDENTIAL, FIRST 1,OOOSF, PC
101-0000-42600
0
$51.49
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $244.97
DESCRIPTION
ACCOUNT -
QTY
AMOUNT
PLAN CHECK DEPOSIT - ADDITION%REMODEL
101-0000-42600
1
$125.00
Total Paid for PLAN CHECK DEPOSIT - ADDITION/REMODEL: $125.00
DESCRIPTION
ACCOUNT.
QTY
.AMOUNT
RECORDS MANAGEMENT FEE - MAJOR
101-0000-42416
0
$20.00
I Total Paid for RECORDS MANAGEMENT FEE - MAJOR: $20.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$23.41
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$18.72
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
$53.05
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$145.12 .
Total Paid for REMODEL: $240.30
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$13.00
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $13.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: . $5.00
9