BSPN2016-00172
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
RW REAL ESTATE INC
P O BOX 447
LA QUINTA, CA 92247
c&t�p 4 4 Qumz
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BSPN2016-0017
51570 AVENIDA VALLEIO
773132003
RW REAL ESTATE INC / SPECIAL INSPECTION
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.:
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 require the applicant for the permit to file a
signed statement that he or she is licensed puant to the provisions of the
Contractor's State License Law (Chapter 9 (c mencing with Section 7000) of Division
of the Business and Professions Code) or at he or she is exempt therefrom and the
ba 's for the alleged exemption. Any viol at
of Section 7031.5 by any applicant for a
Rer ' subjects the applicant to a c , ivil p aIty of not more than five hundred dollars
k M0, as wner of the property, or employees with wages as their sole
com ensatio will do the work, an he structure i's not intended or offered for sale.
(Sec. 7044, Bus ess and Professio Code: The Contractors' State License Law does not
apply to an owne f property wh builds or improves thereon, and who does the work
himself or herself tAct
his or er own employees, provided that the improvements
are not intended od for ale. If, however, the building or improvement is sold
yvithin one year of 'on heowner-builder will have the burden of proving that
she did not bim ove for the purpose of sale.).
I, as owner oo am exclusively contracting with licensed contractors
to construct the pr( c. 70 ,.Business and Professions Code: The Contractors'
State License Law apply to n owner of property who builds or improves
t eon, and who s for the pr 'ects with a contractors) licensed pursuant to
t Contractors'tnse Law.).I am exempt Sec. B. for this eason
Date: iOwner:
CONSTRUCTION LENDING A E' CY
I hereby affirm nder penalty of perjury that there is a c ction lending agency for
the performance of the work for which this permit is issue Sec. 3097, Civ. C.).
Lender's
Lender's
10
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS(760)777-7153
Date: 2/11/2016
R L EST��T E INC
P 0 O 447--u
LALQOE111TI, Le,2 4;
CITY OF LA QUIT WT` �J
EMMUNITY DEVEL09MENT OEPgRTMENT
_.
Llc. No.:
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 work 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 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 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:
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 ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED'FOR IN SECTION 3706 OF THE 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 information is correct.
I agree to comply with all city and county ordinances and stajelaws relating to building
construction, and hereby authorize representatives of this ity to nter upon the
above-mentioned property for inspection purposes.
Date:��Signature (Applicant or -Agent)
FINANCIAL INFORMATION
DESCRIPTION' ACCOUNT QTY
AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION 101-0000-42404 0
$72.52
$72.52
2/11/16
PAID BY METHOD
RECEIPT #
CHECK #
CLTD BY
RW REAL ESTATE INC DEBIT
R12848
RSE
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$72.52
$72.52
Description: RW REAL ESTATE INC / SPECIAL INSPECTION
Type: SPECIAL INSPECTION Subtype:
Status: UNDER REVIEW
Applied: 2/11/2016 RSE
Approved:
Parcel No: 773132003 Site Address: 51570 AVENIDA VALLEJO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 53
Lot: 22
Issued:
UNIT 5
NAME TYPE NAME ADDRESSI CITY
Lot Scl Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $0.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: ILLEGA CONSTRUCTION, ELECRICAL RELEAS. THIS IS NOT FOR ANY WORK.
ADDITIONAL
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE NAME ADDRESSI CITY
STATE 21P PHONE
FAX -EMAIL
APPLICANT RW REAL ESTATE INC P 0 BOX 447 LA QUINTA
CA 92247 (760)619-7611
'jarsanto@gmail.com
OWNER RW REAL ESTATE INC P 0 BOX 447 LA QUINTA
CA 92247 (760)619-7611
jarsanto@gmail.com
Printed: Thursday, February 11, 2016 12:07:15 PM 1 of 2R
SYSTEMS
INSPECTIONS
PARENT PROJECTS
BOND INFORMATION
ATTACHMENTS
Printed: Thursday, February 11, 2016 12:07:15 PM 2 of 2. ,
SYSTEMS
Bin #
Cf tY of La Quin to
Building 8F Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet-
Permit #
s Addres�
n ���Owner's Name:
A. P. Number:
Address: .) r
Legal Description:
City, ST, Zip:
Contractor:
one•
Telephone: � — 1 1
Address:
Project Description:
City, ST, Zip:
Telephone: Po
ele h e:
p�� �r
1 U ;
State Lie. # :
City Lie. #;
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone: hone:
tructi e• Occupancy: (,N
Construction
n TYP UW
Lie. #:
Demo
Add'nP �circle o e : New Alter
Project
Name,of Contact Person:
Sq. Ft.:
# Stories: `
#Units:
Telephone # of Contact Person:
r
Estimated Value of Project: J rkv�-,)w6h
APPLICANT: DO NOT WRITE BELOW THIS LINE
H
Submittal
Req'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cates.
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.T.
II.O.A. Approval
Plans resubmitted
Grading
IN I{OUSE:-
Jrd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called.Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees