BRES2019-013678-495 CALLE TAMPICO V VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/21/2019
Permit Type/Subtype: BUILDING RESIDENTIAL/REMODEL Owner:
Application Number: BRES2019-0136 BRENT EVANS
Property Address: 55610 ROYAL ST GEORGE 55610 ROYAL ST GEORGE
APN: 767522005 LA QUINTA, CA 92253
Application Description: REIFF / CASITA AND SFD REMODEL
Property Zoning: �y
Application Valuation: $15,000.00
Applicant: D Contractor:
DAZ DESIGN BUILD INC MAY 2 3 2019 DAZ DESIGN BUILD INC
PO BOX 5083 1-) PO BOX 5083
LA QUINTA, CA 92248 CITY OF LAQUINTA LA QUINTA, CA 92248
(760)895-4331
Llc. No.: 944325
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 Cil�Jssspp: License No.: 44 5
Date: �lj Contractor:
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 Ad
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 t� rk For which this permit is issued.
47
1 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: NORGUARD INSURANCE COMPANY Policy Number: DAWC099252
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' compensatlo 110Vlsions of Sect -ton 3700 a the Labor Code, I shall forthwith
comply wit those pr Isions.
Date: �2 Applicant:
WARN YG: 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
constructio , and hereby authorize representatives of tacittar upon the
above-� ion d property for inspection purposes.
Date: V f Signature (Applicant or Agent
Date: 5/21/2019
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
DAZ DESIGN BUILD INC
PO BOX 5083
LA QUINTA, CA 92248
BRES2019-0136
55610 ROYALST GEORGE
767522005
REIFF / CASITA AND 5FD REMODEL
$15,000.00
Owner:
BRENTEVANS
55610 ROYAL ST GEORGE
LA QUINTA, CA 92253
Contractor:
DAZ DESIGN BUILD INC
PO BOX 5083
LA QUINTA, CA 92248
(760)895-4331
Llc. No.: 944325
Detail: 494 SF REMODEL TO MAIN DWELLING AND DETACHED CASITA, INCLUDING TWO BEDROOM AND TWO BATH ADDITION AT MAIN DWELLING, WITH
ADDITION OF BED AND BATH AT CASITA. NO ADDITION TO LIVING SPACE, MODIFICATION TO LATERAL RESISTING CONSTRUCTION, FENESTRATION, OR
MECHANICAL CHANGEOUTS INCLUDED IN SCOPE OF THIS PERMIT. 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
CASH OVER
101-0000-42300
0
$125.00
Total Paid for CASH OVER: $125.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$26.68
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$26.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
DEVICES/FIXTURES, ADDITIONAL
101-0000-42403
0
$122.82
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES/FIXTURES, ADDITIONAL PC
101-0000-42600
0
$30.82
Total Paid for ELECTRICAL: $207.00
DESCRIPTION
ACCOUNT
CITY
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
FIXTURE/TRAP
101-0000-42401
0
$160.08
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$160.08
Total Paid for PLUMBING FEES: $320.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
101-0000-42600
($24.01)
DESCRIPTION
ACCOUNT
CITY
AMOUNT
101-0000-42600
($19.21)
DESCRIPTION
ACCOUNT
CITY
AMOUNT
101-0000-42600
($54.43)
DESCRIPTION
ACCOUNT
CITY
AMOUNT
101-0000-42600
($27.35)
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$24.01
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$19.21
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
$54.43
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$27.35
DESCRIPTION
ACCOUNT
CITY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600 1
0
$121.54
Total Paid for REMODEL: $121.54
DESCRIPTION
ACCOUNT
CITY AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0 $1.95
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.95
DESCRIPTION
ACCOUNT
CITY AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0 $5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
• ••.
Contractor Name: � �--i 211
1
Address:
City, St, Zip
Telephone: a
Email: /Yv j - C11 ?-
State Lic: &1 44•3rc City Bus Lic:
Architect/Engineer Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic: City Bus Lic:
Property Owner's Name: 0K
Address: Sic [ D
City, ST, Zip V,
Telephone:
Email: I �1%' (e & D U_
? jVjL 1 New SFD Construction:
Conditioned Space
Garage
Patio/Porch
G��✓L Fire Sprinklers
Construction
Grading:
Bedrooms: I Stories
SF
SF
SF
SF
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type; Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
AP
# Submittal Required Received
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License
I
w:cnrwma flee:vcalra nr
May Tne.
AND MhIM MAR TO:
J bRunA ao�np
5707J.0
Aaa,Ca
CA 91302
CMd►r Na0. VII1Nolt4
ILP.H.: Ter.L74-0,a,; TRA. 020e1a
2019-0094145
tld/2e/2619 t17:41 Pa Fe•: a 17.00
Pap loft
01—ded 1, off A.1:l R•eerds
P• •l ryAl i'R' •re fd
f■■.ff.*•>er�twwiky C1.rX-R•evr d. r0A
et
THE UNDERSIGNED ORAHTOR181 DECLAR151S) GRANT OECD
DDCUMENTARY TRANSFER TAXIS $ f 375, 00
x ] crxrrpul0d on full value of properlycanvolrod, or
] Cumflulcd vn fun yprdfl IW4 yakm of Iran, w ancimrbrancar rammining at lkne of sale.
] vnincflrpomisd a+nm [ x J Cdy of Ls t]uin,
FOR A VAi.UMLE CON SI Dfi RAT ION, r otg of Wtrkh it heraby achAm r dM.
John g" Evam. A Man4od Alan as"Sole and S"Tme Propafty and Pets D. PAPIWn, A Ikfa rrlad Alan sa his
Hale ■nd a"fMO Prnpafgr and Witon C. Ksravitaa, An Unman ed Ron arpd Jsmaa H. Watau n Jr.. A Mauled Mw
w h!s Ella and 111sPafaM Psppany and Sradlay R. as ]a{ni Lsrranfa ParMaf, A Marded Man ops m his Sofa and Srate PropwW a
I100ntYGRANTW10 Jerry N. Rolff and Donnie S. Relff AKA Sauslle S. Goldatelf
as Truateea or The Roxff Twat A reement dated November 17, 20Da
sha fallowln0 drrcrrtwd real MoWy in t CtfNfty of RMank4, swo o1 Caldrxma
Saa Ea1Hbn A' attached harer0 and rrlade a Pan h rW.
Crrsx tyknown a: SMI0 fiuW V Goow. La Cvwum. CA M53
Dsoad: f *WLwy 13.W#
A �i PIAso aae►rrafloru�++vkrsrp ar arreRcar
�w1aa d/y i7a WIrAq d � Y+dMA! i ewip afd`ad tly
!b � M 4rnr�:laa a a�draq av3 rot ar
anew"
C
} a8. I G Apt
f 4-d
is r
14RTML1 l�47{[Y E=i
trC]TftR1' fYlAt i"
^7"�'"6 sr�if of �ola,�an
r eraaPPOLPrprMkRAMW "Allf"r Ofsr H1dY]IPIYIf}.�:ir:+fiiffSAfi
mrrdS�+s+ "
+rsr�s.risw+.rsra.a :.r
wawa
(low
1
[ilr aaia tr of fow r-am, asa11
RECEIVED
MAY 13 2019
CITY OF LA QUINTA
DESIGN AND DEVELOPMENT DEPARTMENT
[A�k �P j Rma 4 '4.% 0 IVA" --Alt
*(EIM L M IKWVM QANJIS QNV ,LNAWXVJ 'H LNfl (I I AH31S A-U� IHQ ON*
,LNaWAHH9V UTAWHS