BRES2017-0269�J ui�lw
78-495 CALLE TAMPICO C�
LA QLIINTA;`CALIFORNIA 92253 ``'''^'''
DESIGN &DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: BUILDING RESIDENTIAL/REMODEL
Application Number: BRES2017-0269
Property Address: 53725 AVENIDA VALLEJO
APN: 774122026
Application Description: STOCKDALE / CONVERT EXISITNG GAME ROOM TO BEDROOM
Property Zoning:
Application Valuation: $35,000.00
Applicant:
LENCH DESIGN STUDIO INC
PO Box 450 DEC 0.4 2417
LA QUINTA, CA 92253 P D
CITY OF LA QUINTA
DESIGN AND DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty ofperjury 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.:
�z �� i Contractor:
' 1
tD�e: /
OWNER-BURDER DECLARATION
hereby affirm under penalty of perji/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).:
LJ 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:
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 Na
Lender's Address:
VOICE (760) 777-7125
FAX (760)
INSPECTIONS (760) 777-7153
Date:. 12/4/2017
Owner:
CHARLES STOCKDALE
Contractor:
TBD
Llc. No.:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one.:)f the following declarations:
I have and will maintain a certificare of consent to self -insure for workers'
compenstion, a ,.provided for by Section 3700 of the Labor Code, for the performance
o�t�epc:' r.which this permit is issued.
Ihave and will maintain workers'compensation insurance, as required by
Sec700 of the Labor Code, for the perfoirmance 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 ofithe work for which this permit is issued, I
shall not employ any person in any manner sc as t come subject to the workers'
compensation laws of California, and agree tP.at;' hould become subject to theme_
workers' compensation provisions of Section 37 of the Labor Code, I sh 11 -forthwith
comply with those provisions:
�• Z'01-' IApplicant:
WARNING: FAILURE TO SECURE WORK CGMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIAAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100;000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FO'I 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 -he 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 to a 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 issu; nce 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 a ove inf mation is correct. .
I agree to comply with all city and county ordinances an s ate la relating to building
construction, and hereby authorize representad6ves o hi city t enter upon the abov
mentioned property for inspection purposes'
Date: Z 0q' ISi`�ture(ApplicantorJgen G
fes' �
Date: 12/4/2017
Application Number: BRES2017-0269
Owner:
Propeity'Address: '53725 AVENIDA VALLEJO
CHARLES STOCKDALE
APN: 774122026
50855 WASH-NGTON NO C217
Application Description: STOCKDALE /CONVERT EXISITNG GAME ROOM TO BEDROOM
LA QUINTA, CA 0
Property Zoning:
Application Valuation: $35,000.00
Applicant:
Contractor:
LENCH DESIGN STUDIO INC
TBD
PO BOX 450
LA QUINTA, CA 92253
----------------------------------------------------------------------------------------------
Llc. No.:
Detail: CONVERSION OF EXISTING 330 SF GAME ROOM INTO DETACHED CASITA, INCLUDING ADDITIONAL NEW MaHANICAL AT BATHROOM, NEW
ELECTRICAL, NEW BATHROOM PLUMBING, AND NEW WINDOWS (5) AND FRENCH DOORS (1 SET). THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK
WALLS, OR DRIVEWAY APPROACH. 2016 CALIFORNIA BUILDING CODES.
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
DEVICES, FIRST 20
101-0000-42403
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$26.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVI CES/FI XTU RES, ADDITIONAL.
101-0000-42403
0
$15.60
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES/FIXTURES, ADDITIONAL PC
101-0000-42600
.0
$3.90
Total Paid for ELECTRICAL: $71.52
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$38.01
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP PC
10.1-0000-42600
0.
$38.01
• Total Paid for PLUMBING FEES: $76.02
DESCRIPTION.
ACCOUNT
QTY
AMOUNT.
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$23.41
DESCRIPTION
ACCOUNT
QTY
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 j
$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
$4.55
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $4.55
DESCRIPTION ACCOUNT QTY AMOUNT
TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
0