BELC2014-100978-495 CALLE TAMPICO .
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
HERMOSA LANDSCAPE
54-415 AVE RUBIO
LA QUINTA, CA 92253
Tit!t 4 4 Qumro
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BELC2014-1009
51377 AVENIDA CARRANZA
773081023
200 AMP PANEL CHANGE
=120000 RECEIVED
JUL 24 2014
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JANEL AUSTIN
51377 AVENIDA CARRANZA
LA QUINTA, CA 92253
Contractor:
HERMOSA LANDSCAPE
54-415 AVE RUBIO
LA QUINTA, CA 92253
(760)831-8749
Llc. No.: 904557
Date: 7/24/2014
LICENSED CONTRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
1 hereby affirm under penalty of perjury one of the following declarations:
(commencing with Section 7000) of Division 3 of the Business and Professions Code, and
_ I have and will maintain a certificate of consent to self -insure for workers'
my License is in full force and effect,
compensation, as provided for by Section 3700 of the Labor Code, for the performance of
License Class: C27 C-8 B License No.: 904557
the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
)(Date: Contractor. �- , YL---
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 any
compensation laws of California, and agree that, if I should become subject to the
structure, prior to its issuance, also requires the applicant for the permit to file a signed
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
statement that he or she is licensed pursuant to the provisions of the Contractor's State
comply with those provisions.
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
Date -)!Q77 -q 2A j 4 Applicant: e f�
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).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
(_) I, as owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
compensation, will do the work, and the structure is not intended or offered for sale.
HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that he
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
or she did not build or improve for the purpose of sale.).
the conditions and restrictions set forth on this application.
(_) I, as owner of the property, am exclusively contracting with licensed contractors to
1. Each person upon whose behalf this application is made, each person at whose
construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State
request and for whose benefit work is performed under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon, and
as a result of this application, the owner, and the applicant, each agrees to, and shall
who contracts for the projects with a contractor(s) licensed pursuant to the Contractors'
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
State License Law.).
employees for any act or omission related to the work being performed under or
(_) I am exempt under Sec. . B.&P.C. for this reason
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
Date: Owner:
for 180 days will subject permit to cancellation.
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 Na
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 enter upon the above-
mentioned property for inspection purposes.
Date: �y Signature (Applicant or Agent): (:f-- /
of utnta
Buil gpg SE Safety Divison
P.O. Box 1504, •7&495 Calle Tampico
La.Quinta, CA 92253 •:(760) 77T7012
Building Pennit Application'and Tracking Sheet
Permit #
Project Address: 7
Owner's Name:.
A. P. Number
Address: f5137-1 ref F1.L�
Legal Description:
City, ST, Zip:
Cofactor: M
Telephone:
Project Description:
Address: 3o10y S (
City, ST, Zip: TA&," •g ad
'7b 0 g3I 7KStawLic.#:
opTelephone:
gOyS cT-7b
t i.Ilb7q
Arch., Engr., Designer:
Address:
City' ST, Zip.
Telephoae:Construction
Type:. ,0,; q Occupancy:
State Lic. #:
Name of Contact Person: iW E4 MALA,
Project type (circle one): New Add'n Alter (Ee:pg> Demo
Sq. Ft.: #Stories: #Units:
Telephone # of Contact Person: 16 p -7f q
Estimated Value of Project 2,00. do
APPLICANT: DO NOT WRITE BELOW THIS UNE
H
Submittal
ReWd
Recd
TRACKING
PERMrFEES-
Plan Sets
Pian Check submitted
item Amount
Structural Cala.
Reviewed, ready for corrections
Plan Check Deposit,
Truss Cala.
Called Contact Person
Pian Cheek Balance.
Title 24 Cates.
Plans picked up
Construction
Flood plain pian
Plans resubmitted - ,
Mechanical
Grading plan
2'! Review, ready for correctionn%ssue
Electrical
Subcoatactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
L
ML
H.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
''' Review; ready for eorreetianMane
Developer Impact Fee
Planning Approval.
Called Contact Person
AXP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
FINANCIAL 1 .
DESCRIPTION
ACCOUNT QTY AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE
101-0000-20306 0 $1.00
$0.00
PAID BY
METHOD RECEIPT # ` '
CHECK #
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SERVICES
101-0000-42403
0
$23.83
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SERVICES PC
101-0000-42403
0
$11.92
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for ELECTRICAL: $35.75 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$90.57
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $90.57 $0.00
TOTALS:00
DESCRIPTION
1
PermitTRAK
$127.32
BELC2014-1009 Address: 51377 AVENIDA CARRANZA Apn: 773081023
$127.32
BUILDING STANDARDS ADMINISTRATION BSA
$1.00
BSAS SB1473 FEE
101-0000-20306
0 $1.00
ELECTRICAL
$35.75
SERVICES
101-0000-42403
0 $23.83
SERVICES PC
101-0000-42403
0 $11.92
PERMIT ISSUANCE
$90.57
PERMIT ISSUANCE
TOTAL FEES ..RECEIPT:R493
101-0000-42404
0 $90.57
$127.32
Date Paid: Thursday, July 24, 2014
Paid By: HERMOSA LANDSCAPE
Cashier: PJU
Pay Method: DEBIT
Printed: Thursday, July 24, 2014 11:54 AM 1 of 1 CRIffCVITI kIt Z