BSPN2014-0009 (BSPN)46650 Adams Street Suite 101
78-49S CALLE TAMPICO
Carrier: _ Policy Number: _
LA QUINTA, CALIFORNIA 92253
Application Number:
BSPN2014-0009
Property Address:
46650 ADAMS ST 101
APN:
600390029
Application Description:
GAS RELEASE ONLY
Property Zoning:
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3
Application Valuation:
$100.00
Applicant:
OCEAN WEST BUILDERS INC
13811 DANIELSON STREET
POWAY, CA 92064
"Np 4 eiditii QuiRS
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
JUL 18 2014
IY OF LA QUINTA
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 7000) of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License lass::8 License No.: 568530
Date.: ` v / / Contractor,.
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/18/2014
Owner:
INLAND AMERICAN LAQUINTA PAV
P O BOX 9271
OAK BROOK, IL 92253
Contractor:
OCEAN WEST BUILDERS INC
13811 DANIELSON STREET
POWAY, CA 92064
(858)486-0371
Llc. No.: 568530
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 thew 71rfor 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:
OWNER -BUILDER DECLARATION
Carrier: _ Policy Number: _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Section 3700 of the Lab% Code, I shall hwith
signed statement that he or she is licensed pursuant to the provisions of the -
comply with those provisions.
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
ate: / Applicant:
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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(_) 1, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.).
1. Each person upon whose behalf this application is made, each person at whose
(_) 1, as owner of the property, am exclusively contracting with licensed contractors
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
employees for any act or omission related to the work being performed under or
the Contractors' State License Law.).
following issuance of this permit.
(_) I am exempt under Sec. B.&P.C. for this reason
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.
Date:
Owner:
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:
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 nter up t e o e.
mentioned property for inspection purposes.
s- /
tate:Signature (Applicant or Agent): 4 r -
DESCRIPTION
ACCOUNT
CITY
AMOUNT. "
PAID
PAID DATE
SPECIAL INSPECTION
101-0000-42404
1
$71.50
$71.50
7/21/14
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
OCEAN WEST BUILDERS INC
DEBIT
R426
AOR
Total Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTION: $71.50 $71.50
•