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BPLB2016-0108LICENSED 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 Professions Code, and my License is in full force and effect. License Class: C2G7 License No.: 1010859 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 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 Address: 1 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 k 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: MARKEL INSURANCE COMPANY ?olicy Number: MWC0079994 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 a; 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. Date: Applicant:l� ✓�� 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 ($100,000t.. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR JN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOM&EDGEMENT 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 applicztion is made, each person at whose request and for whose benefit work is performed underor 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 foP 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 representatves of this city toe r er upon the above-mentioned property for inspection purposes. e Date: -�� ^� r Signature (Applicant c r Agent VOICE (760) 777-7125 78-495 CALLE TAWPICO. D FAX(760)777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN &DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT .Application Number: BPLB2016-0108 Owner: at . 8/29%2016 UJ Property Address: 55515 RIVIERA MACKLIN RICK APN: 775242011 55515 RIVIERA c� Q w� Application Description: MACKLIN / GAS LINE FOR BBQ _ LA QUINTA, CA 92253 = �[ Property Zoning: LUI Application Valuation: $3,650.00 as Applicant: Applicant: Contractor: LL UJi c� O w ' CREATIVE ENVIRONMENTS COMPANY LLC ( r p CREATIVE ENVIROf�MENTS COMPANY LLC�g Q V �_ 80-346 WHITEHAVEN DRIVE 80-346 WHITEHAV--N DRIVE INDIO, CA 92203 INDIO, CA 92203, (760)912-1559 LIc. No.: 1010859. 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 Professions Code, and my License is in full force and effect. License Class: C2G7 License No.: 1010859 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 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 Address: 1 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 k 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: MARKEL INSURANCE COMPANY ?olicy Number: MWC0079994 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 a; 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. Date: Applicant:l� ✓�� 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 ($100,000t.. IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR JN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOM&EDGEMENT 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 applicztion is made, each person at whose request and for whose benefit work is performed underor 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 foP 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 representatves of this city toe r er upon the above-mentioned property for inspection purposes. e Date: -�� ^� r Signature (Applicant c r Agent Date: 8/29/2016 Application Number: BPLB2016-0108 Owner: Property Address: 55515 RIVIERA MACKLIN RICK APN: 775242011 55515 RIVIERA Application Description: MACKLIN /GAS LINE FOR BBQ LA QUINTA, CA 92253 Property Zoning: Application Valuation: $3,650.00 Applicant: Contractor: . CREATIVE ENVIRONMENTS COMPANY,LLC CREATIVE ENVIROWENTS COMPANY LLC 80-346 WHITEHAVEN DRIVE 80-346 WHITEHAVEN DRIVE INDIO, CA 92203 INDIO, CA 92203 (760)912-1559 Llc. No.: 1010859 --------------------------------------------- ----------------------------------------------- Detail: (1)25LF OF 3/4" POLY FUSION GAS LINE IN 11/2" SLEEVE FOR BBQ ONLY. DOES NOT INCLUDE ELECTRICAL OR OTHEF. GAS OUTLETS. 2013 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION. . DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDSADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT CITY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $91.85 Total Paid for PERMIT ISSUANCE: .$91.85 DESCRIPTION ACCOUNT QTY . AMOUNT GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 !0 $12.09 DESCRIPTION ACCOUNT QTY -AMOUNT GAS SYSTEM, 1-4'OUTLETS PC 101-0000-42600 0 $24.17 Total Paid for PLUMBING FEES: $36.26 TOTALS: $129. lain 1l Permit # Project Address: _ �� City of La Quinta Building 81- Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet. ✓f f� Owner's Name: ?'flck ml tc V) Y: A. P. Number: Address: v s-- 5�5 P/ t v/ erA Legal Description: City, ST, Zip: Contractor: .i // G hone• �% Address: (/037/(0 .P, , �ekow' W r -Telephone: Project Description:A-Wei City, ST, Zip: —Tin I f)' g 7W e Tlehne: 0 P 1)2t 2 7 U 9 5 i� ss State l:ic. # :- City Lie. #.: Arch.,'Engr., Designer: Address: . City, ST, Zip: Telephone: e ne: 0 Construction ccu ani on T YP e: OP Y: State Lic. 4. Project ty Pa circle one • New Add'n Alt✓r Re air Demo. " Name of Contact Person: Sq. Ft.: # Stories: #Units/: Telephone # of Contact Person: - Estimated Value of Project:gem ?J Ips APPLICANT: DO NOT WRITE BELOW THIS LINE !� Submittal Req'd Rcc'd TRACKING PERvIIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposil Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Cales.Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN IiOUSE:- Review, ready for corrections/issue Developer Impact IFee Planning Approval Called Contact Person A.1.P.P. Pub. Wks. Aper Date of permit issue School Fees, Total Permit Fees � b some ) Vt, Sleeve - b I OH1,13obbitt Land4qpe Manager PGA West Re's. Assoc. Inc.. , *m 'was s BELOW .1 .40 -1-1 Z_ L!� m�- I I -zww paw. ... . .. ' - - 3 -- -- -.------- OA OAK % '.c 4 i I GATE K owwo F1 4A_/j0(c-A7EJ AATrliAW_u. SLAALFACC OAA4,ad,-E QL'L , nv� CITY OF LA QUINTA' BUILDING & SAFETY DEPT. APPR0VED FOR CONSTRUCTION DATE -BY