BSPN2016-0059a
78-495 CALLE TAMPICO., 4
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BSPN2016-0059
Property Address: 52700 AVENIDA RAMIREZ
APN: 773292009
Application Description: USE BANK / ELECTRICAL UTILITY (IID) RELEASE
Property Zoning:
Application Valuation:
Applicant: .
STEVEN SCHEINWALD
PALM SPRINGS, CA 92253
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: License No.:
tDaat ontmct'o�r:
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 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
0omp�'�n
subjectsthe applicant to a civil penalty of not more than five hundred dollars
sowneroftheproperty, or my employees with wages as their solesation, will do the work, and the structureis not intended or offered for sale.
(Sec. 7044, Business and Professions Code: The Contractors' State License Law doe�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 improvemehfis sold
#g:p)
one year of completion, the owner -builder will have the burden of proving that
ddnotbuild or improve for thepurposeofsner ofthe property,am exclusively contracting with licensed contractors
uct 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
Aeand whocontractsfor the projects with a contractor(s) licensed pursuant to
ractors'State License Law.).m exempt under Sec. B.& C. for this reaso
aYea 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 Na
Lender's Add
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/31/2016
Owner:
HENRY HILDEBRAND
P O BOX 1115
LA QUINTA, CA 92:.53
AUG 3ji-2016
CITY OF LA QUINTA
C0Mh1UNIT' DEVELOPMENT DEPARTMENT
Llc. No.:
-1 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 of the Labor Code, for the performance
of the work for which this permit is issued.
41 " 1 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:_ Policy Number: _
I certify that in the performance of tie 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 37. 00 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 appliotion becomes null and void if work is
not commenced within 180 days from date of ssuance of such permit, or cessation of
work for 180 days will subject permit to cancelation.
I certify that I have read this application and state that the above inform tion is c rrect.
I agree to comply with all city and county ordinances and state laws r ing to u di
construction, and hereby authorize representa#ives f this city to ent r Pon e
above -me tione property for inspection p s
Date S`gnatUr ('Applic "
r^ .
i" Date: 8/31/2016
Application Number: BSPN2016-0059 Owner::
Property Address: 52700 AVENIDA RAMIREZ HENRY HILDEBRAND
APN: 773292009 P-0 BOX 1115
Application Description: USE BANK / ELECTRICAL UTILITY (IID) RELEASE LA QUINTA, CA 92253 .
Property Zoning:
Application Valuation:
Applicant: Contractor:
STEVEN SCHEINWALD
PALM SPRINGS, CA 92253
Llc. No.:
Detail: THIS JOB CARD IS NOT FOR ANY WORK. ONLY (IID) RELEASE `
r
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SPECIAL INSPECTION
1
101-0000-42404
0
$72.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
SPECIAL INSPECTION
101-0000-42404
0
$0.52
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SPECIAL INSPECTION PC
101-0000-42600
0
$181.29
Total Paid for COMPLIANCE•SURVEY/SPECIAL INSPECIION:
TOTALS
$253.81
r
r
1