12-0630 (RER)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:�fi?fl;
Property Address: 49341'GUIJARRO PL
APN: 646-270-029- -
Application description: REMODEL - RESIDENTIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 6000
Applicant:
Architect or Engineer:
M
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
DOUG ZIMMERMAN
49341 GUIJARRO PLACE
LA QUINTA, CA 92253
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/17/12
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 Professionals Code, and my License is in full force and effect.
License Class: License No.:
Date: 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
an}' applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
(� ) 1, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
1111 __ 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.).
(_) 1, 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.).
{ 1 . I am exempt under Sec. / , B.&P.C. for this reason
Date: � E - ? ZPlwner.
CONSTRUCTION LENDING AGENCY
1 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 Address:
LQPERMIT
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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 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
3700 of th tabor e, I sliOVorthwyk eornply with those provisions.
,gate:fnrWARNO 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 Director of Building and Safety 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 ordinance and state laws relating to build7,ns"tZ
on, and hereby authorize representatives
of this county to enter on the above-mentioned propertyn pyr.7lgses.
bate: ' g ture (Applicant or Agent):
Application Number . . . . . 12-00000630
------ Structure Information MASTER
BATHROOM REMODEL [CONV]
-----
Other struct info . .
----------------------------------------------------------------------------
. . . CODE
EDITION 2010
Permit . . . . ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . .
34.50
Plan Check Fee
8.63
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
1/13/13
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
20.00 .7500
PER ELEC
DEVICE/FIXTURE 1ST 20
15.00
10.00 .4500
----------------------------------------------------------------------------
EA ELEC
DEVICE/FIXTURE >20
4.50
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . .
81.00
Plan Check Fee
52.65
Issue Date . . . .
Valuation . . . .
6000
Expiration Date . .
1/13/13
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
4.00 9.0000
----------------------------------------------------------------------------
THOU BLDG
2,001-25,000
36.00
Permit . . . MECHANICAL
Additional desc . .
Permit Fee . . . .
26.00
Plan Check Fee
6.50
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
1/13/13
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
1.00 4.5000
EA MECH
VENT INST/ DUCT ALT
4.50
1.00 6.5000
----------------------------------------------------------------------------
EA MECH VENT FAN
6.50
Permit . . .
PLUMBING
Additional desc . .
Permit Fee . . . .
42.00
Plan Check Fee
10.50
Issue Date . . . .
Valuation . . . .
0
Expiration Date . .
1/13/13
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
LQPERMIT
Application Number . . . . . 12-00000630
Permit . . . . . . PLUMBING
Qty Unit Charge Per Extension
4.00 6.0000 EA PLB FIXTURE 24.00
1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00
----------------------------------------------------------------------------
Special Notes and Comments
MASTER BATHROOM REMODEL (CONVENTIONAL]
REMOVE GUEST BEDROOM HALLWAY TO ENLARGE
SHOWER, TOILET ROOM AND CLOSET AREAS,
AND CREATE DETACHED GUEST SUITE. THIS
PERMIT DOES NOT INCLUDE ADDITIONAL
CONDITIONED SQUARE FOOTAGE. 2010
CALIFORNIA BUILDING CODES.
July 16, 2012 10:50:32 AM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
ENERGY REVIEW FEE 5.27
STRONG MOTION (SMI) - RES .60
Fee summary Charged Paid Credited Due
Permit Fee Total 183.50 .00 .00 183.50
Plan Check Total 78.28 .00 .00 78.28
Other Fee Total 6.87 .00 .00 6.87
Grand Total 268.65 .00 .00 268.65
LQPERMIT
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