BRES2016-035978-495 CALLE TAMPICO
:LA QUINTA, CALIFORNIA 92253
TA14t 4 44P QUM&.
DESIGN &.DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/7/2017 ✓
Permit Type/Subtype:
BUILDING RESIDENTIAL/ADDITION
Owner:
Application Number:
BRES2016-0359
SHANE SIMMONS
Property Address:.
53145 AVENIDA VALLEJO
53145 AVENIDA VALLEJO
APN:
774052030
LA QUINTA, CA 52253
Application Description:
SIMMONS / 686SF BEDROOM AND LIVING ROOM ADDITION
Property Zoning:
Application Valuation:
$39,239.20
Applicant:
tractor:
SHANE SIMMONSNOVO
% 2017
NER / BUILDIR
53145 AVENIDA VALLEJO
LA.QUINTA, CA 92253
.
CITYOFLAQUINTA
COMMUNITY DEVELOPMENTDEPARTMENT
Llc. No.:
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1
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.: &Zeo
Date: ContractoA� p
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.).
(_) 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: _4ZOwner: awe
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:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one d the following declarations:
I have and will maintain a certificat=_ of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I 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: 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 =700 of the Labor Code, I shall forthwith
comply with those provisions.
Date:
Applicant:
WARNING: FAILURE TO SECURE WORKERS' CO%APENSATION COVERAGE 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 FOF 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 _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 6suance 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 ordirances and state laws relating to building
construction, and hereby authorize representar:ives of this city to a ter upon the
above-mentioned property for inspection purp uses.
Date: j);ih Signature (Applicant x Agent): 00,
-
Date: 11/7/2017.
Application Number:
BRES2016-0359
Owner:
Property Address:
53145 AVENIDA VALLEJO
SHANE SIMMONS
APN:
774052030
53145 AVENIDA VALLEJO
Application Description:
SIMMONS / 686SF BEDROOM AND LIVING ROOM ADDITION
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$39,239.20
Applicant:
Contractor:
SHANE SIMMONS
OWNER / BUILDER
53145 AVENIDA VALLEJO
LA QUINTA, CA 92253
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Llc. No.:
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Detail: 6865F BEDROOM AND LIVING ROOM ADDITION ONLY [ENGINEERED] THIS PERMIT DOES NOT INCLUDE REMODEL TO THE EXISTING DWELLING OR
CHANGEOUT OF EXISTING HVAC OR WATER HEATING APPLIANCES. 2013 CALIFORNIA BUILDING CODES.
W.,
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
QTY
AMOUNT
ADDITION, EA ADDITIONAL 500 SF
101-0000-42400
0
$130.72
DESCRIPTION
ACCOUNT
QTY
AMOUNT
ADDITION, EA ADDITIONAL 500 SF PC.
101-0000-42600
0
$36.48
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 ADCITION: .$474.24
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
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
OTHER MECHANICAL EQUIPMENT
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
OTHER MECHANICAL EQUIPMENT PC
101-0000-42600
0
$38.00
Total Paid for MECHANICAL: $76.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$88.69
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$88.69
DESCRIPTION
ACCOUNT
iQTY
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: $202.72
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$5.10
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $5.10
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMEN- FEE: $5.00