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BELC2015-00147$D495 CALLE 1 LA QUINTA, CA Application Num Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: TESERRA PO BOX 1280 COACHELLA, CA 92236 V, 4 etfv Q�&r(v COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT 53635 AVENIDA BERMUDAS 774135018 TESERRA/FRANZESE/ELECTRIAL FOR NEW PORTABLE SPA/ $7,000.00 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: C-8, C27, C10, C29, C53 License No.: 65 8 Date:,Zl/ /, 1 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 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 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 Name: Lender's VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: FH RANCH P 0 BOX 1166 AGOURA HILLS, CA 92253 Contractor: TESERRA PO BOX 1280 COACHELLA, CA 92,236 (760)398-9222 Llc. No.: 656128 . Date: 2/18/2015 z Lcm ri ¢w 0 N LU °p 3 $ .-i U_ W M v W v It Z WORKER'S COMPENSATION DECLARATION 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' ompensation, as provided for by Section 3700 of the Labor Code, for the performance f the work for which this permit is issued. Pj4have and will maintain workers' compensation insurance, as required by ection 3700 of the Labor Code, for the performance of the work for which this permit issued. My workers' compensation insurance carrier and policy number are: arrier: _ Polity Number: I certify that in the performance of the work for which this permit is issued, I hall not employ any person in any manner so as to become subject to the workers' ompensation laws of California, and agree that, if I should become subject to the corkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith omply((with those provisCi�s. /T/'/��_ _-• -.- ate:— ( ) Applicani.. DARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, ND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIESAND CIVIL FINES UP TO iNE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF OMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, JTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT WPORTANT:Application is hereby made to the Building Official for a permit subject to ie conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose quest and for whose benefit work is performed under or pursuant to any permit ;sued as a result of this application , the owner, and the applicant, each agrees to, and - hall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and mployees for any act or omission related to the work being performed under or Alowing issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is of commenced within 180 days from date of issuance of such permit, or cessation of cork for 180 days will subject permit to cancellation. certify that I have read this application and state that the above information is correct. agree to comply with all city and county ordinances and state laws relating to building onstruction, and hereby authorize representatives of this city to enter upon the above- ientioned property for inspection purposes. late: — ( H ,Signature (Applicant or Agent): FINANCIAL DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total'Paid forBUILDING STANDARDS -ADMINISTRATION BSA $1.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT 4 PAID' PAID DATE APPLIANCES, RES 101-0000-42403 0 $12.09 $0.00 PAID BY METHOD • RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE APPLIANCES, RES PC 101-0000-42600 0 $12.09 $0.00 PAID BY METHOD • RECEIPT # CHECK # CLTD BY Total Paid for ELECTRICAL: $24.18 $0.00 DESCRIPTION ACCOUNT • QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:0r Description: TESERRA/FRANZESE/ELECTRIAL FOR NEW PORTABLE SPA/ Type: ELECTRICAL Subtype: Status: UNDER REVIEW Applied: 2/18/2015 SKH Approved: Parcel No: 774135018 Site Address: 53635 AVENIDA BERMUDAS LA QUINTA,CA 92253 Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 240 Lot: 7 Issued: UNIT 23 Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $7,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NAME Details: ELECTRICAL -HARD WIRE FOR NEW PORTABLE SPA WITH LOCKABLE COVER. 2013 CALIFORNIA BUILDING CODES. Printed: Wednesday, February 18, 2015 3:14:57 PM 1 of 2 (r2l7 SYS7Eti1S ADDITIONAL CHRONOLOGY CONDITIONS NAME TYPE NAME ADDRESSI CONTACTS CITY STATE ZIP PHONE FAX EMAIL APPLICANT TESERRA PO BOX 1280 COACHELLA CA 92236 CONTRACTOR TESERRA PO BOX 1280 COACHELLA CA 92236 OWNER FH RANCH P 0 BOX 1166 AGOURA HILLS CA 92253 Printed: Wednesday, February 18, 2015 3:14:57 PM 1 of 2 (r2l7 SYS7Eti1S DESCRIPTION ACCOUNT, CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY APPLIANCES, RES 101-0000-42403 0 $12.09 $0.00 APPLIANCES, RES PC 101-0000-42600 0 $12.09 $0.00 Total Paid forELECTRICAL: $24.18 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 1 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:0• ATTACHMENTS Printed: Wednesday, February 18, 2015 3:14:57 PM 2 of 2 cr—m—rvsrrnns Bin # City of La Quinta. Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico. La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit# Project Address: 53 6 A L c -,n (.� Owner's Name: pS <52 A. P. Number: D e r 1M Address: 3 9 57 4,,e Legal Description: City, ST, Zip: ✓v� �S Contractor: Telephone: •`•:':>:»' >>:#'<::>'.>`'. Address: r7 6 , q L Project Description: City, ST, Zip: C 0 CC t'�f // C— 1-)Y' ( C +r .' C �' (/�' Telephone: �6 31 C�C! 6 /- ' State Lie. #: City Lie. #: Arch., Engr., Designer: Address: City., ST, Zip: Telephone: #:: ;;;::;;::;.:;;>;;: <:r<:<:::;:>< ;:•z:<z.<;>. •>:• ,..:..:...........: Construction Type: Occupancy: State Lie. type (circ e ne): eProAdd'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # torie's: # Units: Telephone #,of Contact Person: Estimated Value of Proje v� APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance, Title 24 Calcs. 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.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- srd Reyiew, ready for eorrcctionsCssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees _� �1 �. � i �'� � t