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BELC2016-009978-495 CALLE TAMPICO LA QUINTA, CALIFORNIA -92253 Application Number: Property Address: APN: . Application Description Property Zoning: Application Valuation: DESIGN & DEVELOPMENT DEPARTMENT BELC2016-0099 52700 AVENIDA RAMIREZ 773292009 US BANK TRUST/ ELECTRIC Ln $1,000.00 Applicant: ROD JACKSON & ASSOCIATES INC 346 AVENIDA RE ROYALE THOUSAND OAKS, CA 91362 BUILDING PERMIT V DEC 0 7 2016 DESIGNANDp OFA Q�INTA EVELOPMENT 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 Class: C10, B License No.: 717168 T�Contractor: OWNER -BUILDER DECLA ION 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 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 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 contractor(s) 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 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/7/2016 Owner: US BANK TRUST /MA 13801 WIRELESS WY OKLAHOMA CITY, -DK Contractor: ROD JACKSON & A6SOCIATES INC 346 AVENIDA RE ROYALE THOUSAND OAKS,:CA 91362 (805)379-4361 Llc. No.: 717168 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of :he following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 :)f the Labor Code, for the performance of the work for which1his 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: Carrier: STATE COMPENSATION INSURANCE FUAD Policy Number: 1746567 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 a to become subject to the workers' compensation laws of California, and agree than, if I should become subject to the workers' compensation provisions of Section 3XO of the Labor Code, I shall forthwith comply with those provisions. Date% / Applicant: WARNING: FAILURE TO SECURE WORKERS' COMP NSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000): IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 'APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned roperty for inspection purposes. Da–te-)60�$Signature-(ApplicanY.rr Qent): i Date:. 12/7/2016 Application Number: BELC2016-0099 Owner: Property Address: 52700 AVENIDA RAMIREZ US BANK TRUST /P7A APN: 773292009 13801 WIRELESS WY Application Description: US BANK TRUST/ ELECTRICAL OKLAHOMA CITY, -DK Property Zoning: . Application Valuation: $1,000.00 Applicant: Contractor:' ROD JACKSON & ASSOCIATES INC ROD JACKSON & ASSOCIATES INC. 346 AVENIDA RE ROYALE 346 AVENIDA RE ROYALE THOUSAND OAKS, CA 91362 THOUSAND OAKS, -CA 91362 (805)379-4361 -------------------------------------------------------------------------------------- Llc. No.: 717168 Detail: REPLACE 200 AMP ELECTRICAL PANEL. PER 2013 CALIFORNIA BUILDING CODE i Ci FINANCIACINFORMATION i" DESCRIPTION ACCOUNT PITY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 El Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT -D.TY AMOUNT SERVICES 101-0000-42403 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT SERVICES PC 101-0000-42600 0 $12.67 Total Paid for ELECTRICAL: $38.00 ' DESCRIPTION ACCOUNT D.TY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27