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13-0852 (SPIN)j P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00000852 Property Address: 78750 CABRILLO WY APN: 646-420-028- - - Application description: SPECIAL INSPECTION Property Zoning: LOW DENSITY RESIDENTIAL Application valuation: 2476 Applicant: Architect or Engineer: 4ev BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 Professionals Code, and my License is in full force and effect. License Class: License No.: Date:4/ Contractor: v 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 g,a)pplicant 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.). A 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 9�/ property who builds or improves thereon, and,ho contracts for the projects with a contractor(s) licensed ny pursuant to the Contractors' State License a ). / 1 ) I am exempt under Sec. e.&P.C. is reason �#z 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 Address: LQPERMIT Owner: JP MORGAN CHASE BANK 1111 POLARIS PARKWAY COLUMBUS, OH 43240 (760)409-5958 Contractor: Owner VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 7/10/13 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 far' which this permit is issued. My workers' compensation insurance carrier and policy 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. Da � 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 Director of Building and Safety 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 becom null and void if work is not commenced within 180 days from date of issuance of such per ' , or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the abo e i formation is cc e I agree to comply with all city and county ordinances and state laws relating to buildin c truction, and r y authorize representati s of this counttyl to enter upon the above-mentioned property action purpo 1) a te. Signature (Applicant or Agent Application Number . . . . . 13-00000852 Permit . . SPECIAL INSPECTION Additional desc . . Permit Fee . . . . 71.50 Plan Check Fee .00 Issue Date Valuation . . . . 2476 Expiration Date 1/06/14 Qty Unit Charge Per Extension 1.00 71.5000 EA MISC SPECIAL INSPECTION 71.50 ---------------------------------------------------------------------------- Special Notes and Comments ELECTRICAL SPECIAL INSPECTION. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary ----------------- Charged -------------------- Paid Credited -------------------- Due Permit Fee Total 71.50 .00 .00 71.50 Plan Check Total .00 .00 .00 .00 Other Fee Total 1.00 .00 .00 1.00 Grand Total -72.50 .00 .00 72.50 LQPERMiT - ' t Bin # 15'(6 Qty of LA Qu(nta Building 8i' Safety Division P.O. Box 1504, 78495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: ;4 e1q �' C) Owner's Name: Mckc-J A. P. Number: 6 L( (C - ►-1 d © Address: c ' S Legal Description: (Z (>-r` -% (::-5 City, ST, Zip: C* L, ? Contractor: Address: -'S r :, telephone: �Q 5� `� "" Project Description: 1 CLS City, ST, Zip: Telephone:, State Lic. # : City Lic. #, Arch., Engr., Designer. Address: City., ST, Zip: Telephone' .ri; , Construction Type: Occupancy State Lic. #: Project type circle one New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: 1 # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Pian Check Balance Title 24 Cates. Plans picked up Construction Flood plain plan Pians resubmitted Mechanical Grading pian 2'" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.L H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 'i° Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit Issue School Fees Total Permit Fees