BRES2017-0275LICENSED 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
my License is in full force and effect.
License Class:/B. C54, C-8 License No.: 93 .
tDate`- lam` l contractor: n `�an
�
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I— _ I have and will maintain a certificate of consent to self -insure for workers'
com ion, as provided for by Section 3730 of the Labor Code, for the performance
th rk for which this permit is issued.
ain ain"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:
OWNER -BUILDER DECLARATION &_11, Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9033995
1 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, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any ' shall not employ any person in any manner sa 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 becoFo
structure, prior to its issuance, also requires the applicant for the permit to file a signed workers' compensation provisions of Section. 370 the Labor ode, 1 shalrt h�
statement that he or she is licensed pursuant to the provisions of the Contractor's State comply with those pr visions. //
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 Date �App� lican�
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).: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COV tt EIS UNLAWFUL,
I 1 1, as owner of the property, or my employees with wages as their sole . AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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 IMPORTANT: Application is hereby made to zhe Building Official for a permit subject to
or she did not build or improve for the purpose of sale.): the conditions and restrictions set forth on this application.
(� 1, as owner of the property, am exclusively contracting with licensed contractors to 1. Each person upon whose behalf this appeication 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 performed 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, and the 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 Cita of La Quinta, its officers, agents, and
Contractors' State License Law.). employees for any act or omission related torthe 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 issuance of such permit, or cessation of work
Date: Owner: Ifor 180 days will subject permit to cancellation
CONSTRUCTION LENDING AGENCY I certify that I have read this application and :tate that the above i
I hereby affirm under penalty of perjury that there is a construction lending agency for I agree, to comply with all city and county orcinances and state
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize represen:atives of this tW
mentionedprop� for inspection purposes.
Lender's Name: , �/i //�— /
Lender's Add
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D . ..—T
FAX (760) 777-7011
LXQUINTk CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date:. 10/10/2017
Permit Type/Subtype: BUILDING RESIDENTIAL/REMODEL
Owner:
Application Number: BRES2017-0275
SILVIA GOMEZ*
Property Address: 51840 AVENIDA RUBIO
51840 AVENIDA RUBIO
APN: 773162005
LA QUI NTA, U. 92253 ® W
Application Description: GOMEZ RESIDENCE / NEW WATER PIPING & DRYWALL
Property Zoning:
^ ¢ w
Application Valuation: $6,000.00
CM
o N z
aW
Applicant:
A A MAX CONSTRUCTION
;L��
Contractor: o
�_ o
QUALITY
31325 VIA LAS PALMAS
A A MAX QUABITY CON STiF� CTION�
31325 VIA LAS PALMAS G i
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276— CD
0
v
(760)844-4045•
Llc. No.: 91973B
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
my License is in full force and effect.
License Class:/B. C54, C-8 License No.: 93 .
tDate`- lam` l contractor: n `�an
�
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I— _ I have and will maintain a certificate of consent to self -insure for workers'
com ion, as provided for by Section 3730 of the Labor Code, for the performance
th rk for which this permit is issued.
ain ain"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:
OWNER -BUILDER DECLARATION &_11, Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9033995
1 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, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any ' shall not employ any person in any manner sa 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 becoFo
structure, prior to its issuance, also requires the applicant for the permit to file a signed workers' compensation provisions of Section. 370 the Labor ode, 1 shalrt h�
statement that he or she is licensed pursuant to the provisions of the Contractor's State comply with those pr visions. //
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 Date �App� lican�
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).: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COV tt EIS UNLAWFUL,
I 1 1, as owner of the property, or my employees with wages as their sole . AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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 IMPORTANT: Application is hereby made to zhe Building Official for a permit subject to
or she did not build or improve for the purpose of sale.): the conditions and restrictions set forth on this application.
(� 1, as owner of the property, am exclusively contracting with licensed contractors to 1. Each person upon whose behalf this appeication 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 performed 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, and the 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 Cita of La Quinta, its officers, agents, and
Contractors' State License Law.). employees for any act or omission related torthe 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 issuance of such permit, or cessation of work
Date: Owner: Ifor 180 days will subject permit to cancellation
CONSTRUCTION LENDING AGENCY I certify that I have read this application and :tate that the above i
I hereby affirm under penalty of perjury that there is a construction lending agency for I agree, to comply with all city and county orcinances and state
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). construction, and hereby authorize represen:atives of this tW
mentionedprop� for inspection purposes.
Lender's Name: , �/i //�— /
Lender's Add
I
Date: 10/10/2017
Application Number: BRES2017-0275
Owner:
Propertycldr�ss ^_._ " 1•51840 AVENIDA RUBIO
SILVIA GOMEZ
APN: 773162005
51840 AVENIDA RUBIO
Application.Description: .GOMEZ RESIDENCE/ NEW WATER PIPING & DRYWALL
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $6,000.00
Applicant:
Contractor:
A A MAX QUALITY CONSTRUCTION
A A MAX QUAUITY CONSTRUCTION
31325 VIA LAS PALMAS
31325 VIA LAS PALMAS
THOUSAND PALMS, CA 92276
THOUSAND PALMS, CA 92276
(760)844-4045
--------------------------------------------------------------------------------------------------
LIc. No.: 919733
Detail: REPIPE WATER LINE OVERHEAD, DRYWALL ENTIRE HOUSE, AND REINSTALL CABINETS. PER 2016 CAtIFORNIa BUILDING CODE
i
I
FINANCIAL •R •
...DESCRIPTION ACCOUNT QTY AMOUNT
PERMIT ISSUANCE 101-0000-42404 0 $98.83
Total Paid for PERMIT ISSUANCE: $98.83
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$13.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-426000
$13.00
Total Paid for PLUMBING FEES: $26.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE - MAJOR
101-0000-42416
0
$20.00
Total Paid for RECORDS MANAGEMENT FEE -MAJOR: $20.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
50210000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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City of La Quinta
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit#
01CJu
Project Address: "ID
AV -64f,61
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Owner's Name:
A.P. Number
Address: / �-i Cn/1 / n/y R0Qfo
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Legal Description:
City, ST, Zip: /
Contractor:,� / „k
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Telephone:
Address: t3Z� ' V_A
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Project Description'
City, ST, Zip:
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Telephone p ---�p
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State Lic. #:
City Lic #:
A� �,a f 77
Arch, Engr., Designer:
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Address:
14)5n4 ��. (S
City, ST, Zip:
Telephone'
State Lic. #:
Construction Type:
Proj. Type New Add'n
Occupancy:
Altei Repair Demo
Name of Contact:
SgFt:
#Stories
# Units:
Telephone ofContact:�
b�/r�
Estimated Value ofP o' t. 6
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERM r FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Cales
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
Mecharical:
Grading Plan
2nd Rev, Ready for corrections /
Electrical:
Subcontractor List
Called Contact Person
Plumbi®g:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Gradin€
1N -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
M_
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