BRES2017-032719'
78-495 CALLE TAMP.ICO C1 0 D `�i(tilU�il/
LA QUINTA, CALIFORNIA 92253 "'
DESIGN &DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: BUILDING RESIDENTIAL/REMODEL
Application Number:
BRES2017-0327
Property Address:
80753 VIA PESSARO
APN:
777160040
Application Description:
STEELBERG / REMODEL
Property Zoning:
Application Valuation:
Applicant:
DAVID JACOBSEN BUILDING CO
49-950 JEFFERSON ST #130-'134
,INDIO, CA 92201
D A 0
JAN 0 8 2018 10
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I fiereby 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.: 457228
Date: #4q1 Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the ractor'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
andProfessions 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.).
( 11, 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.).
U 1 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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/8/2018
Owner:
RYAN STEELBERG
32 BLUE HERON
IRVINE, CA 92253
Contractor:
DAVID JACOBSEN BUILDING CO
49-950 JEFFERSON ST #130-134
INDIO, CA 92201
(760)413-8863
Llc. No.: 457228
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 th k for which this permit is issued.
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 COMPENSATION INSURANCE FUND Polity Number: 9045509
_ 1 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 thos provisions..
Date: i I Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION CO GE IS UNLAWFUL,
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 actor 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 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 city to enter upon the above-
mentioned property for inspection purposes.
Date: Signature (Applicant or Agent):
V
Date: 1/8/2018
Application Number: BRES2017-0327
Owner:
Property Address: 80753•VIA PESSARO
RYAN STEELBERG
APN: 777160040
32 BLUE HERON
Application Description: STEELBERG / REMODEL
IRVINE, CA 92253
Property Zoning:
Application Valuation:
Applicant:
Contractor:
DAVID JACOBSEN BUILDING CO
DAVID JACOBSEN BUILDING CO
49-950 JEFFERSON ST #130-134
49-950 JEFFERSON ST #130-134
INDIO, CA 92201
INDIO, CA 92201
(760)413-8863
-----------------------------------------------------------------------------------------------
Llc. No.: 457228
Detail: REMODEL OF SOUTHWEST EXTERIOR WALL TO ACCOMMODATE NEW FRAMING, TWO NEW WINDOWS' AND FRENCH DOORS, WITH ADDITIONAL
ELECTRICAL FOR LIGHTING AND LIGHTING.CONTROL AT FRENCH DOORS: THIS PERMIT DOES NOT INCLUDE ANY ADDITIONAL INTERIOR OR EXTERIOR
WORK. 2016 BUILDING CODES.
S
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PARTITION
101-0000-42600
0
($125.00)
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - CITY BUILDING STAFF
101-0000-42600
1
$125.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - CITY BUILDING STAFF
101-0000-42600
0
$31.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
HOURLY CHARGE - CITY BUILDING STAFF
101-0000-42600
1.
$156.00
Total Paid for BLDG CITY STAFF - PER HOUR: $187.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-000042600
0
$26.01
Total Paid for ELECTRICAL: $52.02
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PARTITION
101-0000-42400
0
$78.02
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PARTITION PC
.101-0000-42600
0
$143.56
Total Paid for PARTITION: $221.58
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PLAN CHECK DEPOSIT - ADDITION/REMODEL
101-0000-42600
1
$125.00
Total Paid for PLAN CHECK DEPOSIT - ADDITION/REMODEL: $125.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE - MAJOR
101-000042416
0
$20.00
1 Total Paid for RECORDS MANAGEMENT FEE - MAJOR: $20.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00-
5.00.DESCRIPTION
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, EA ADDITION 1
101-0000-42400
0
$10.92
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, EA ADDITION 1 PC
101-0000-42600
0
$12.48
DESCRIPTION
ACCOUNT
QTY
'AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1
101-0000-42400
0
$104.03
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, NEW/ALT, FIRST 1 PC
101-0000-42600
0
$118.59
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, RETRO/REPAIR, FIRST
101-0000742400
0
$65.54
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DOOR/WINDOW, RETRO/REPAIR, FIRST PC 101-0000-42600 .0 $63.98
Total Paid for WINDOW/SLIDING GLASS DOOR/FENESTRATION: $375.54
TOTALS: $986.14
l