BRES2019-006078-495 CALLE TAMPICO T4h/ D 'i - Qu&&i
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: BUILDING RESIDENTIAL/REMODEL
Application Number:
BRES2019-0060
Property Address:
52525 AVENIDA BERMUDAS
APN:
773305013
Application Description:
DORSEY/ INTERIOR REMODEL AND RE -ROOF
Property Zoning:
Application Valuation:
$10,000.00
Applicant:
UNDER CONSTRUCTION D
18300 FORD AVE
DESERT HOT SPRINGS, CA 92241 MAR 2 0 2019
CITY OF LA QUINTA
DESIGN & DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
{commencing with Section 70001 of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Clas"sy:�License No,:
ft � I ` tontcactor:
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:
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 Addre!
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/20/2019
Owner:
RICHARD HAGERTY
Contractor:
UNDER CONSTRUCTION
18300 FORD AVE
DESERT HOT SPRINGS, CA 92241
(760)972-7721
Llc. No.: 909599
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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 thRYork for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
o Sec 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 INSURAECE FUND Policy Number: 9019557
_ 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.
Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 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 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.
Dat Aili—1 9tgnature (Applicant orAgenzm��
Date: 3/20/2019
Application Number:
BRES2019-0060
Property Address:
52525 AVENIDA BERMUDAS
APN:
773305013
Application Description:
DORSEY/ INTERIOR REMODEL AND RE -ROOF
Property Zoning:
Application Valuation:
$10,000.00
Applicant: - - - -
UNDER CONSTRUCTION
18300 FORD AVE
DESERT HOT SPRINGS, CA 92241
Owner:
RICHARD HAGERTY
--Contractor----
UNDER CONSTRUCTION
18300 FORD AVE
DESERT HOT SPRINGS, CA 92241
(760)972-7721
Llc. No.: 909599
--------------------------------------,----------.----- ---------------------------------
ii
Detail: INTERIOR REMODEL- REVISED LAYOUT AT KITCHEN, NEW LIGHTING AND PLUMBING FIXTURES AT BATHROOMS AND KITCHEN. REMOVE AND RE-
SET ENTIRE ROOF TILE . THIS PERMIT DOES NOT INCLUDE ALTERATIONS TO THE HVAC SYSTEM OR FIREPLACE. THIS PERMIT DOES NOT INCLUDE ANY
INCREASES TO THE CONDITIONED/LIVING SQUARE FOOTAGE. 2016 CALIFORNIA BUILDING CODES.
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$26.68
Total Paid for ELECTRICAL: $53.36
DESCRIPTION
ACCOUNT
CITY
AMOUNT
EXHAUST HOOD
101-0000-42402
0
$13.34
DESCRIPTION
ACCOUNT
CITY
AMOUNT
EXHAUST HOOD PC
101-0000-42600
0
$5.34
Total Paid for MECHANICAL: $18.68
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
CITY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$40.02
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$40.02
DESCRIPTION
ACCOUNT
CITY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$13.34
DESCRIPTION
ACCOUNT
CITY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$26.68
Total Paid for PLUMBING FEES: $120.06
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
$54.43
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$148.89
Total Paid for REMODEL: $203.32
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RE -ROOF - FIRST 2,000 SF
101-0000-42404
0
$54.43
DESCRIPTION
ACCOUNT
CITY
AMOUNT
RE -ROOF - FIRST 2,000 SF PC
101-0000-42600
0
$108.87
Total Paid for RE -ROOF: $163.30
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$1.30
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.30
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 10 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
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PERMIT #
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PLAN
Project Address:
~�1JJe_ 4V(44
LOCATION:
Project Description:
Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
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Applicant Name:��—
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Address;
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Telephone;
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Email: � � � � l ,®J j�pj Valuation of Project $ I t •[�[�(�
Contractor Name:
Address: + vr_ 6orA
City, St, Zip �i
Telephone: < ` 2 5� 7>
Email: [
State Lic: q Oq S y C1 City Bus Lic:
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic:
Property Owner's Name:
Address: _
City, ST, Zip G
Telephone:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000