Loading...
12-0505 (SPIN)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/08/12 Application Number: 12-00000505 Owner: Property Address: 53781 AVENIDA CARRANZA ALEXSA GOBEL APN: 774-155-014-4 -000000- 53781 AVENIDA CARRANZA Application description: SPECIAL INSPECTION LA QUINTA, CA 92253 a Property Zoning: COVE RESIDENTIAL D Application valuation: 100 MAY 0 8 2012 Contractor: Applicant: Architect or Engineer: CASTLE CONSTRUCTION 68670 LOS GATOS CITY OF LA QUINTA CATHEDRAL CITY, CA 92234 FINANCE DEPT. (760)272-4191 LiC. No.: 675800 ---------------------------------------------------------------------------------------- _ LICENSED CONTRACTO 'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury thfansed r p isions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Busineessio Is e, and my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: B cense No.: 675800 _ for by Section 3700 of the Labor Code, for the performance of the work for which this permit is LL �x ate: J �..Q r. ntractor: v issued. ' 1 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor —mpt Code, for the performance of the work for which this permit is issued. My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perju t I am exeIV from the Contractor's State License Law for the Carrier CNCLD/ST FUND Policy Number 1863381-2012 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance oft rk for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so bjec[ to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I shouldct to the workers' compensation provisions of Section ��oe License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, h comply with those provisions. 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).: � �^/ ate: � plicant: (_ 1 1, 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). APPLICANT ACKNOWLEDGEMENT 1 _ 1 I, as owner of the property, am exclusively contrarting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of uuriditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, (_ 1 I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City Date: Owner: CONSTRUCTION LENDING AGENCY 1 hereby affirm under penaltyof 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: l _ Lender's Address: M LQPERMIT 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 tion of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the ab a inf n is correct. I agree to comply with all city and county ordinances and state laws relating to building o ct ,and hereby authorize representatives of this county to enter upon the above-mentioned prop rt ion purposes. te: r - I ature (Applicant or Agent): Application Number . . . 12-00000505 Permit . . . SPECIAL INSPECTION Additional desc . Permit Fee . . . . 100.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 100 Expiration Date 11/04/12 Qty Unit Charge Per Extension BASE FEE 100.00 ---------------------------------------------------------------------------- Special Notes and Comments SPECIAL INSPECTION TO VERIFY THAT POOL ENCLOSURE HAS SELF-CLOSING, SELF -LATCHING 5' GATE. OA.$6# Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 100.00 .0.0 00 100.00 Plan Check Total .00 .00 .00 00 Grand Total 100.00 .00 .00 100.00 LQPERMIT 1 Bfn.# Cit/ of La Quihtd ' Bulldfig & Safety Division P.O. Box 1504,78-495 Calle Tampico La.Qainta, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking Permit # Project Address: /Sheet Owner's Name:.A. P. Number.Address: 77. C( 6. ,Dr. (C -1p Legal Description: / Contractor LS (�, `SfG v Ce' Dti, / - City, ST, Zip: GF. zz� Telephone: 1111 > Address: (?j © �d� A Project Description: City, ST, Zip: �S �r't I IG� S rrti� S Telephone: '7(o� ZiL �p ,�f'=a 5 et �d �G citN� State Lic. #: 7S g oo City Lic. #; Arch., Engr., Designer Address: City., ST. Zip: Telephone: State Lic. #: `-�, ..�� - -Construction Type:.. Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: #Stories: #Univ Telephone # of Contact Person: Estimated Value of Project APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Recd TRACMG PERMIT FEES Plan Sets Pian Check submitted Item Amount Structural CRlcs. Reviewed, ready for corrections Plan Check Deposit. . Truss Calm. Called Contact Person Plan Check Balance_ Tide 24 Calci. Pians picked up Construction hood plain plan Plans resubmitted Mechanical Grading plan 2`f Review, ready for correctionskssue Electrical Subeontaetor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- 'i6 Review, ready for eorrectionsfissue Developer Impact Fee Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees'