BRES2017-0217LICENSED 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.: 926128 II C� ( L
Date: 10- q (1 Contractor. _ QK61r
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 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.).
(_J 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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
GAYLORD DAVIS
56525 RIVIERA
LA QUINTA, CA 9253
Date: 10/9/2017
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78-495 CALLE TAMPICO _
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LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype:
BUILDING RESIDENTIAL/REMODEL
INDIO, CA 92201
Application Number:
BRES2017-0217
Property Address:
56525 RIVIERA
APN:
762022011
Application Description:
DAVIS / INTERIOR REMODELWITH WINDOW INSTALLATION
Property Zoning:
Application Valuation:
$15,000.00
Applicant:
DANTOR MARTINEZ CONSTRUCTION
81057 AVENIDA ROMERO
INDIO, CA 92201
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.: 926128 II C� ( L
Date: 10- q (1 Contractor. _ QK61r
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 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.).
(_J 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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
GAYLORD DAVIS
56525 RIVIERA
LA QUINTA, CA 9253
Date: 10/9/2017
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WORKER'S COMPENSAr,ON DECLARATION
I hereby affirm under penalty of perjury one ofthe following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 370C of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' campensation 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 polity number are:
Carrier: EXEMPT Policy Number: _
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 3100 of the Labor Code, I shall forthwith
comply with those provisions. n I k )
Date: 16 -1 -11 Applicant: '_NA" It Cil I A ani
WARNING: FAILURE TO SECURE WORKERS' COFAPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINI4L PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000. 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 owne and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the --ity 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 cancelbtion.
I certify that 1 have read this application and st2te that the above information is correct.
I agree to comply with all city and county ordinances and stapte laws relating building
construction,. and hereby authorize representatives of this cit6t to 1 enter upof e
above-mentioned property for inspection purp )ses.
Date: "� " 1 Signature (Applicant :)r Agent):
N
Contractor:
DAN TOR MARTINEZ
CONSTRUCTION]
81057 AVENIDA ROMERO
INDIO, CA 92201
(760)702-2921
Llc. No.: 926128
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WORKER'S COMPENSAr,ON DECLARATION
I hereby affirm under penalty of perjury one ofthe following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 370C of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain workers' campensation 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 polity number are:
Carrier: EXEMPT Policy Number: _
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 3100 of the Labor Code, I shall forthwith
comply with those provisions. n I k )
Date: 16 -1 -11 Applicant: '_NA" It Cil I A ani
WARNING: FAILURE TO SECURE WORKERS' COFAPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINI4L PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000. 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 owne and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the --ity 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 cancelbtion.
I certify that 1 have read this application and st2te that the above information is correct.
I agree to comply with all city and county ordinances and stapte laws relating building
construction,. and hereby authorize representatives of this cit6t to 1 enter upof e
above-mentioned property for inspection purp )ses.
Date: "� " 1 Signature (Applicant :)r Agent):
Date: 10/9/2017
f
AppliraWnAWmber_ BRES2017-0217
Owner:
Property Address: ? 56525 RIVIERA
GAYLORD DAVIS
APN: •762022011
56525 RIVIERA
Application Description: DAVIS /INTERIOR REMODEL WITH WINDOW INSTALLATION
LA QUINTA, CA 9253
Property Zoning:
Application Valuation: $15,000.00
Applicant:
Contractor:
DANTOR MARTINEZ CONSTRUCTION
DANTOR MARTIN --Z CONSTRUCTION
81057 AVENIDA ROMERO
81057 AVENIDA R01VIERO
INDIO; CA 92201
INDIO, CA 92201
(760)702-2921
Llc. No.: 926128
Detail: INTERIOR REMODEL AT KITCHEN, DINING, LIVING AND BATHROOMS INCLUDING WINDOW INSTALLATION AT DINLNG ROOM [ENGINEERED] THIS
PERMIT DOES NOT INCLUDE ADDITIONAL SQUARE FOOTAGE, CHANGEOUT OF MECHANICAL UNITS
OR LIGHTING ALTERATIONS. 2016 CALIFORNIA BUILDING
CODE.
FINANCIAL .•.
' ,,',SVESCRIPTION ACCOUNT QTY
AMOUNT
HOURLY CHARGE - YES ADMINISTRATIVE STAFF
101-0000-42600 0.5
$20.00
DESCRIPTION
ACCOUNT QTY
AMOUNT
HOURLY CHARGE -YES STRUCTURAL PLAN REVIEW ENGINEER
101-0000-42600 2
$190.00
Total Paid for BLDG CITY STAFF - PER HOUR: $210.00
DESCRIPTION
ACCOUNT
QTY
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
$26.01
DESCRIPTION
ACCOUNT
tQTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-4260.0
0
$26.01
Total Paid for ELECTRICAL: $52.02
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
Total Paid for MECHANICAL: $17.74
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$25.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC
1101-0000-42600
0
$25.34
Total Paid for PLUMBING FEES: $50.68
DESCRIPTION.
ACCOUNT
DTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400 •
0
$23.41
DESCRIPTION
ACCOUNT
•D.TY
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
$1.95
Total Paid for STRONG MOTION INSTRUMENTATION 5M1: $1.95
DESCRIPTION
ACCOUNT'
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bing
City of La Quinta
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 7774012
Building Permit Application and Tracking Sha et
Permit#
Project Address: ,i
Owner's Name:
^
A.P. Number
Address:
�4
Legal Description:
City, ST, Zig
Contracto7anV^ Y
Telephone:
v
Address:
Project Description:
Gfi T;Zip:� c�
NO yp
Telephone:
l
b
State Lic. #: —ity Lic #:`
Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type:
Proj. Type New Add'n
Occupancy:
Alter Repair Demo
.Statc-Eio. ##:
Name of Contact:
SgFt:
#Stories
# Units:
Telephone of Contact:
tstimated Value of Project:
AEELI.CA . OT WRITE BELOW THIS LINE
#
Submittal
Req'd
Ree'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Calcs
Reviewed, ready for corrections
Plan Check Deposit:
Truss Calcs
Called Contact Person
Plan Check Balance:
Title 24 Calcs
Plans Picked Up
Construction:
Flood Plain Plan
Plans Resubmitted
Mechanical:
Grading Plan
2nd Rev, Ready for corrections /
Electrical:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading
IN-HOUSE
3rd Rev, Ready for corrections /
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Apps
Date of permit issue
School Fees
Total Permit Fees