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BRES2017-004078-495 CALLE TAMPICOC� A 4.:!.. ilNi�Cl/. LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE.(760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 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: B License No.: 944325 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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).: U 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.). (� 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 Address: (760)285-3793 Llc. No.: 944325 7/7/2017 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 Pion k for which this permit is issued. Ihave and will maintain workers' compensation insurance, as required by 00 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 COMPENSATION INSURANCE FUND Policy Number: 9168769 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 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS U WFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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 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 hull 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 laws relating to building construction, and hereby authorize representatives of this citynter upon the above -menti ed pr pertly for inspection purposes. Date: +Signature (Applicant or Agent): Date: Application Number: BRES2017-0040 Owner: Property Address: 81688 RUSTIC CANYON DR JOHN & JANE HOLMUND��� APN: 764540042 81688 RUSTIC CANYON DR Application Description: HOLMUND RESIDENCE / 281 S.F. ATTACHED CASITA ADDITION LA QUINTA, CA 92253 Property Zoning: o N Application Valuation: $51,000.00 n Applicant: Contractor: [aL J � DAZ DAZ V P 0 BOX 5083 P 0 BOX 5083 -- LA QUINTA, CA 92253 LA QUINTA, CA 92253—� 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: B License No.: 944325 Date: Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that 1 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).: U 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.). (� 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 Address: (760)285-3793 Llc. No.: 944325 7/7/2017 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 Pion k for which this permit is issued. Ihave and will maintain workers' compensation insurance, as required by 00 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 COMPENSATION INSURANCE FUND Policy Number: 9168769 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 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS U WFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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 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 hull 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 laws relating to building construction, and hereby authorize representatives of this citynter upon the above -menti ed pr pertly for inspection purposes. Date: +Signature (Applicant or Agent): Owner: . JOHN & JANE HOLMUND 81688 RUSTIC CANYON DR LA QUINTA, CA 92253 Date: 7/7/2017 Applicant: Contractor: Application Number: BRES2017-0040• Property Address: 81688 RUSTIC CANYON DR APN: 764540042 Application Description: HOLMUND RESIDENCE / 281 S.F. ATTACHED CASITA ADDITION • Property Zoning: Llc. No.: 944325 Application Valuation: $51,000.00 Owner: . JOHN & JANE HOLMUND 81688 RUSTIC CANYON DR LA QUINTA, CA 92253 Date: 7/7/2017 Applicant: Contractor: DAZ DAZ P 0 BOX 5083 P 0 BOX 5083 LA QUINTA, CA 92253 LA QUINTA, CA 92253 (760)285-3793 Llc. No.: 944325 Detail: HOLMUND / 281 S.F. ATTACHED CASITA W/ ATTACHED TOWER ENTRY COVER ATTRONT YARD. 2016 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT ADDITION, EA ADDITIONAL 500 SF 101-0000-42400 0 $65.36 DESCRIPTION ACCOUNT QTY AMOUNT ADDITION, EA ADDITIONAL 500 SF PC 101-0000-42600 .0 $18.24 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: $390.64 DESCRIPTION ACCOUNT QTY AMOUNT HIDURLY CHARGE - YES ADMINISTRATIVE STAFF 101-0000-42600 0.25 $10.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER 101-0000-42600 1 $95.00 Total Paid for BLDG CITY STAFF - PER HOUR: $105.00 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $3.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $3.00 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $152.00 DESCRIPTION ACCOUNT QTY AMOUNT RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $50.16 Total Paid for ELECTRICAL - NEW CONSTRUCTION: $202.16 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $38.00 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE 101-0000-42402 0 $38.00 DESCRIPTION ACCOUNT QTY AMOUNT FURNACE PC 101-0000-42600 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN PC 101-0000-42600 0 $5.07 Total Paid for MECHANICAL: $144.40 DESCRIPTION ACCOUNT . QTY AMOUNT PATIO COVER, DESIGNED 101-0000-42404 0 $139.84 DESCRIPTION ACCOUNT QTY AMOUNT PATIO COVER, DESIGNED PC 101-0000-42600 0 $176.32 Total Paid for PATIO COVER / COVERED PORCH / LATTICE: $316.16 DESCRIPTION ; ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $38.01 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $38.01 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.67 Total Paid for PLUMBING FEES: $101.36 DESCRIPTION ACCOUNT - QTY AMOUNT SMI - RESIDENTIAL 101-0000-20308 0 $6.63 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $6.63 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00