14-0869 (AR)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:
14-00000869
Property Address:
81385 PEARY PL
APN.
767-680-022-60 •-330761-
Application description:
ADDITION - RESIDENTIAL
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
188698
App lica Architect or Engineer:
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LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I m Ii ensed un er p visions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business _ fessio I , and my License is in full force and effect.
Licen_Cass: 13 en No.: 835648
Date - - - - — Contractor: r—
OWNER -BUILD CLARATION
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 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 1, 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
orwerty who builds 4r imereyes thereon. and why contracts for the oroiects with a writractgr(sl licenser)
pursuant to the Contractors' State License Law.).
(_ I I am exempt under Sec. , BAP.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:
LQPERMIT
Owner:
RICHARD & CHRISTENA H. DURHAM
136 E SOUTH TEMPLE 825
SALT LAKE CITY, UT 84111
Contractor:
ENGSTROM CONSTR MANAGE
77455 EVENING STAR
INDIAN WELLS, CA 92210
(760)668-3961
Lic. No.: 835648
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date
JUN 2E. 2014
6/17/14
OF LA QUINTA
1414CE DEPT.._
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WORKER'S COMPENSATION 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 3700 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 STATE FUND Policy Number 9022651
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner o as o become subject to the workers' compensation laws of California,
a d agree that, if 1 s uld co%eu t e rkers' compensation provisions of Section
00 ofthe Labor ode, s 1 co y ith those provisions.
— —
Date � � � App — -
--
WARNING: FAILURE TOS URE WORKERS' CO COVER E IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FI O ONE HUNDRED THOUSAND
DOLLARS ($100,0001. 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 Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Earth rip.mm anon whose behalf this armlicatign 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 the 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 thea ve infor ation is cgrJact. ree to comply with all
city an co my ordi noes and state laws relating tr ct n d eb a h rize representatives
of this ou ty to ant r up the above -mention ` prope for in c u s
Date: � ��✓ � 6i ature (Applicant or Agt�l:� _
Application Number . . . . . 14-00000869
Permit . . .
ROOM ADDITION 2013
Additional desc . .
1.00
143.0000
LS ELEC
Permit Fee . . . .
304.59
Plan Check Fee
.00
Issue Date . . . .
NEW RES, ADD -L 1 KSF
Valuation . . . .
0
Expiration Date
12/14/14
Additional
desc . .
Qty Unit Charge
Per
Extension
1.00 120.1200
LS MISC
ROOM ADDN, 1ST 100 SF
120.12
3.00 61.4900
----------------------------------------------------------------------------
EA MISC
ROOM ADDN, ADDL 500 SF
184.47
Permit . .
Additional desc .
Permit Fee . . .
Issue Date .
Expiration Date .
ELECTRICAL 2013
155.16 Plan Check Fee.. . .00
Valuation . . . . 0
12/14/14
Qty Unit Charge
Per
Extension
1.00
143.0000
LS ELEC
NEW RES, FIRST 1 KSF
143.00
1.00
----------------------------------------------------------------------------
12.1600
EA ELEC
NEW RES, ADD -L 1 KSF
12.16
Permit
. . . MECHANICAL 2013
Additional
desc . .
Permit Fee
. . . .
178.76
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . .
. 0
Expiration
Date
12/14/14
Qty Unit Charge
Per
Extension
2.00
35.7500
EA MECH
FURNACE
71.50
1.00
11.9200
EA MECH
APPL REP/ALT
11.92
2.00
35.7500
EA MECH
CONDENSER/COMP
71.50
1.00
11.9200
EA MECH
VENT FAN
11.92
1.00
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11.9200
EA MECH
EXHAUST HOOD
11.92
Permit
. . .
PLUMBING 2013
Additional
desc.
Permit Fee
. . . .
309.92
Plan Check Fee
.00
Issue Date
. . . .
Valuation . . .
. 0
Expiration
Date
12/14/14
Qty Unit Charge
Per
Extension
5.00
11.9200
EA PLBG
FIXTURE/TRAP
59.60
19.00
11.9200
EA PLBG
ROOF DRAIN
226.48
1.00
11.9200
EA PLBG
WATER INST/ALT/REP
11.92
.1.00
11.9200
LS PLBG
GAS SYS, 1-4 OUTLETS
11.92
LQPERMIT
Application Number . . . . . 14-00000869
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Special Notes and Comments
2ND FLOOR ADDITION WHILE UNDER
CONSTRUCTION,FIRST FLOOR WAS PERMITED
UNDER PERMIT # 13-401. ADDITIONAL SCHOOL
FEES WILL BE REQUIRED AND REVISED
BUILDING FEE WILL BE CHARGED.
June 17, 2014 8:15:47 AM jjohnson.
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Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
8.00
PLAN CHECK,
ELECTRICAL
52.20
PLAN CHECK,
ROOM ADDITION
220.22
PLAN CHECK,
MECHANICAL
109.63
PLAN CHECK,
PLUMBING
321.83
STRONG MOTION (SMI) - RES
18.60
Fee summary Charged Paid
----------------- --- - ------ ----------
Credited
---------- ----------
Due
Permit Fee Total 948.43 .00
.00
948.43
Plan Check Total .00 .00
.00
.00
Other Fee Total 730.48 .00
.00
730.48
Grand Total 1678.91 .00
.00
1678.91
LQPERMIT