The URL can be used to link to this page

BELC2014-100878-495CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: . APN: Application Description Property Zoning: Application Valuation: T4tr4 44u!Krw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BELC2014-1008 78950 HIGHWAY 111 643080004 INSTALLATION OF EIGHT (8) FLOOR RECEPTACLES $25,294.00 Applicant: ENGINEERED STRUCTURES INC DBA 3330 E LOUISE DRIVE STE 300 MERIDIAN, ID 83642 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 usiness and Professio Code, and my License is in full force and effect. License Class: B License No.: 696242 1k Date: '7* 22 ' 14� Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt fr the tractor's State License Law for the following reason (Sec. 7031.5, Business nd P fessions Code: Any city or county that requires a permit to construct, alter, im e, 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 x 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 contractors) 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 Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/22/2014 Owner: KOHLS DEPARTMENT STORES INC N56 W17000 RIDGEWOOD DR MENOMONEE FALLS, WI 92253 Contractor: ENGINEERED STRUCTURES INC DBA 3330 E LOUISE DRIVE STE 300 MERIDIAN, ID 83642 (208)362-3040 Llc. No.: 696242 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 k for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Sion 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and polity number are: Carrier: Policy Number: _ 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 as to become subject to the worker ' compensation laws of California, and agree that, if 1 s uld become subject to workers' compensation provisions of Section 370 f he Labor Code, I shall rthwith comply with those provisions. 7.22 Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION C ERAGE IS LAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ND CIVI NES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITI N �OFTH COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION E 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 inf rmation is correct. I agree to comply with all city and county ordinances and state la s elating to building construction, and hereby authorize representatives of this city a ter upon the abov% mentioned property for inspection purposes. _ W �� Date: ' 22'7 ' 1Q� Signature (Applicant or DESCRIPTION FINANCIAL INFORMATION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS 561473 FEE 101-0000-20306 0 $2.00 $2.00 7/22/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY ENGINEERED STRUCTURES INC DBA DEBIT R469 AOR Total Paid for BUILDING STANDARDS ADMINISTRATION BSA $2.00 $2.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 101-0000-42403 0 $23.83 $23.83 7/22/14 PAID BY METHOD—... RECEIPT # CHECK # CLTD BY ENGINEERED STRUCTURES INC DBA DEBhl _ _ R469 AOR DESCRIPTION ACCOUNT {rl 4 QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 PC 101-0000-42600 0 # $23.83 $23.83 7/22/14 PAID BY METHOD.,, RECEIPT # CHECK # CLTD BY ENGINEERED STRUCTURES INC DBA DEBIT R469 AOR DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SIGNS 101-0000-42403 0 $35.75 $35.75 7/22/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY ENGINEERED STRUCTURES INC DBA DEBIT R469 AOR DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SIGNS PC 101-0000-42403 0 $47.67 $47.67 7/22/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY ENGINEERED STRUCTURES INC DBA DEBIT R469 AOR Total Paid for ELECTRICAL: $131.08 $131.08 DESCRIPTION ACCOUNTQTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $90.57 $90.57 7/22/14 PAID BY METHOD RECEIPT # CHECK # CLTD BY ENGINEERED STRUCTURES INC DBA DEBIT R469 AOR Total Paid forPERMIT ISSUANCE: $90.57 $90.57