BRES2017-0117_� 4
78 495 CALLE TAMPICO � D
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BRES2017-0117
Property Address: 49075 RANCHO POINTE
APN: 602320008
Application Description: FORSTER RESIDENCE / REMODEL AND DEMO
Property Zoning:
Application Valuation: $40,000.00
Applicant:
BRIAN DECOSTER
P 0 BOX 1654
LA.QUINTA, CA 92274
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: B License No.: 541336
IBM vin�i
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 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).:
(_) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure isnot 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 Addre<
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
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'
com nsation, as provided for by Section 3700 of the Labor Code, for the performance
of th rk fo ich this permit is issued.
ave and will maintain workers' compensation insurance, as required by
Sectio 700 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: BENCHMARK INSURANCE COMPANY Policy Number: CST5008340
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 ag4that,if hould become subject to the
workers' compensation provisions of Se0 the Labor Code, I shall forthwith
comply w�it7h those provisions.
Date:' L '7( Applican
WARNING: FAILURE TO SECURE WORKERS' COM PENSA ION CPVERAGE 15 UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA TIES ND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADD ON 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 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 the work being performed under or
following issuance of this permit.
2. Any per 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 ordinances and state IaA r ting to building
construction, and hereby authorize representatives of this c' y to r u on the
above-mentioned property for inspection purposes.
Dater Signature (Applicant or Agent):
Date: 7/7/2017
Owner:
FORVEST INV INC
92253
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Contractor:
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RON SAWYER CONSTRUCTION INC
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78525 AVENUE 41
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BERMUDA DUNES, CA 92203
(760)200-0893
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Llc. No.: 541336
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'
com nsation, as provided for by Section 3700 of the Labor Code, for the performance
of th rk fo ich this permit is issued.
ave and will maintain workers' compensation insurance, as required by
Sectio 700 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: BENCHMARK INSURANCE COMPANY Policy Number: CST5008340
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 ag4that,if hould become subject to the
workers' compensation provisions of Se0 the Labor Code, I shall forthwith
comply w�it7h those provisions.
Date:' L '7( Applican
WARNING: FAILURE TO SECURE WORKERS' COM PENSA ION CPVERAGE 15 UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENA TIES ND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADD ON 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 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 the work being performed under or
following issuance of this permit.
2. Any per 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 ordinances and state IaA r ting to building
construction, and hereby authorize representatives of this c' y to r u on the
above-mentioned property for inspection purposes.
Dater Signature (Applicant or Agent):
Applicant: Contractor:
BRIAN DECOSTER RON SAWYER CONSTRUCTION INC
P 0 BOX 1654 78525 AVENUE 41
LA QUINTA, CA 92274 BERMUDA DUNES, CA 92203
(760)200-0893
Llc. No.: 541336
---------------------------------------------------------------------------------------------
Detail: REMODEL/ ADDITION OF 68 SQUARE FEET OF LIVING AREA (53 SF @ REAR, 13 SF @ FRONT) UNDER EXISTING COVERED PATIO ROOF.'REVISED PATIO
AREAS ARE 475 SF @ REAR, 13 SF @ FRONT) (EXISTING LIVING = 3,428 FS + 68 SF NEW = 3,496 SF) PERMIT INCLUDES TWO INTERIOR FIREPLACES. 2016
CODES.
Date: 7/7/2017
Application.Number: ,.
BRES2017-0117 Owner:
Property Address:
49075 RANCHO POINTE FORVEST INV INC
APN:
602320008
Application Description:
FORSTER RESIDENCE / REMODEL AND DEMO. " 92253
Property Zoning:
Application Valuation:
$40,000.00
Applicant: Contractor:
BRIAN DECOSTER RON SAWYER CONSTRUCTION INC
P 0 BOX 1654 78525 AVENUE 41
LA QUINTA, CA 92274 BERMUDA DUNES, CA 92203
(760)200-0893
Llc. No.: 541336
---------------------------------------------------------------------------------------------
Detail: REMODEL/ ADDITION OF 68 SQUARE FEET OF LIVING AREA (53 SF @ REAR, 13 SF @ FRONT) UNDER EXISTING COVERED PATIO ROOF.'REVISED PATIO
AREAS ARE 475 SF @ REAR, 13 SF @ FRONT) (EXISTING LIVING = 3,428 FS + 68 SF NEW = 3,496 SF) PERMIT INCLUDES TWO INTERIOR FIREPLACES. 2016
CODES.
FINANCIAL •• •
;t' DESCRIPTION ACCOUNT QTY' AMOUNT
ADDITION, FIRST 100 SF 101-0000-42400 0 $127.68
DESCRIPTION ACCOUNT QTY AMOUNT
ADDITION, FIRST 100 SF PC 101-0000-42600 0 $179.36
Total Paid for ADDITION: $307.04
DESCRIPTION
ACCOUNT
QTY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2:00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
-DESCRIPTION
• ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
10.1-0000-42600
0
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIREPLACE
101-0000-42400
0
$152.00
Total Paid for FIREPLACE: $152.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
Total Paid for PLUMBING FEES: $38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$22.80
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$18.24
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
$51.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$141.36
Total Paid for REMODEL: $234.08
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$5.20
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $5.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00 .
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS: