BDEM2014-000349100 Avenida Anselmo
78-4 5 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
BDEM2014-0003
49100 AVENIDA ANSELMO
658280005
DEMO SFD
$13,500.00
IIIIIII VIII III VIII IIII 33
4 auw IE
VOICE (760) 777-7125
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 12/22/2014
Owner:
ROBERT LANGE
P 0 BOX 193
COCKEYSVILLE, MD 92253
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 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 any applicant for
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.).
(XI, 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
Lender's
Contractor:
OWNER BUILDER
Llc. No.:
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 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, 1
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. ___7
gate*AP '/,, 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.
bate: / ---7• 2Z O/Signature (Applicant Agent;
QTY AMOUNT
PAID
PAID DATE
` DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT
DEMOLITION, FULL
101-0000-42404
0
$24.66
$24.66
12/22/14
PAID BY
METHOD
RECEIPT.#•'.
CHECK #
CLTD BY
ROBERT LANGE
CHECK
R3260
6214
PJU
DESCRIPTION
ACCOUNT
QTY •
AMOUNT
PAID
PAID DATE
DEMOLITION, FULL PC
101-0000-42600
0
$87.02
$87.02
12/22/14
PAID BY
METHOD
RECEIPT # .. _
CHECK #
CLTD BY
ROBERT LANGE
CHECK
R3260
6214
PJU
Total Paid for DEMOLITION:' $111.68 $111.68
TOTALS:
Description: DEMO SFD
Type: DEMOLITION
Subtype: SINGLE FAMILY
Status: SUBMITTED
Applied: 12/12/2014 KHE
Approved:
Parcel No: 658280005 Site Address: 49100 AVENIDA ANSELMO LA QUINTA,CA 92253
Subdivision: LA QUINTA GOLF
ESTATES 1 Block:
Lot: 135
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $13,500.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
Details: DEMO EXISTING HOME, FIREPLACE AND SEPTIC TANK TO REMAIN.
CHRONOLOGY
Printed: Monday, December 22, 2014 10:31:31 AM 1 of 2 CE"
SYSTEMS
ATTACHMENTS
Attachment Type
CREATED
OWNER
DESCRIPTION
PATHNAME
SUBDIR ETRAKIT ENABLED
DOC
INSPECTIONS
STEPHANIE KHATAMI
SEQID INSPECTION TYPE INSPECTOR-
SCHEDULED COMPLETED
DATE DATE
RESULT
REMARKS NOTES
PRE -SITE
`
FINAL*"
RETURNED.
STATUS
ATTACHMENTS
Attachment Type
CREATED
OWNER
DESCRIPTION
PATHNAME
SUBDIR ETRAKIT ENABLED
DOC
12/15/2014
STEPHANIE KHATAMI
PM10 DEMO.pdf
PM10 DEMO.pdf
0
REVIEWS
`
RETURNED.
STATUS
REMARKS
REVIEW TYPE
REVIEWER
SENT DATE
DUE DATE
NOTES
DATE
APPROVED
APPROVED WITH COND. P.M. PLAN, BURRTEC
NON-STRUCTURAL
JIM JOHNSON
12/12/2014
12/26/2014
12/12/2014
W/CONDITIONS
APPROVED
WASTE PLAN.
1ST PW GREEN
AMY YU
12/12/2014
12/15/2014
12/12/2014
APPROVED
SHEET
ATTACHMENTS
Attachment Type
CREATED
OWNER
DESCRIPTION
PATHNAME
SUBDIR ETRAKIT ENABLED
DOC
12/15/2014
STEPHANIE KHATAMI
PM10 DEMO.pdf
PM10 DEMO.pdf
0
Printed: Monday, December 22, 2014 10:31:31 AM 2 of 2
R�SYSTEMS