BSPN2015-0020ISO
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
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COMMUNITY DEVELOPMENT DEPARTMENT
VOICE (760)'777-7125,
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number: BSPN2015-0020 wrier:
Property Address: 81739 RANCHO SANTANA DR D Q EVIN VOGT
APN: .767630012 1739 RANCHO SANTANA
Application Description: VOGT RESIDENCE / METER RELEAS �t201C QUINTA, CA 92253
Property Zoning: MAY 2 J
Application Valuation:
Applicant: (OFILA E
VILLA -ELECTRIC, MICHAEL W.
COMMUNfTYDEVE�PMENTDEPtractor:
AFI
OUTSIDE CITY LIMITS
LA QUINTA, 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.: h�
Date Contractor•
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury.that'l 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.).
( )1, 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 Name:
Lender's
Llc. No.:
Date: 5/21/2015
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 policy number are:
Carrier: _ Polity. 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.
DDa/te APPlican" t/: /
WARNING: FAILURE TO SECURE WORKERS' C PENSATION COVERAGE I NLAWFUL,
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..
I. 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 ab
mentioned property for inspection purposes.
A:5 -
Date, /l �' Signature (Applicant or Agent
0
rFINANCIAL
INFORMATION
DESCRIPTION :.�, _
ACCOUNT a . QTY ' +', AMOUNT• !
PAID w , -
PAID DATE.
.:,,
SPECIAL INSPECTION
101-0000-42404 1 $72.52
$72.52
5/21/15
BY,
METHOD4f ,.; #t ",,
CHECK # y 'fir
CLTD BY
4ss"2PAID
, ." f4 rRECEIPT
�'
VILLA ELECTRIC, MICHAEL W.
CHECK MR170
8210
MFA
Total Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTION: $72.52 $72.52
4
Description: VOGT RESIDENCE / METER RELEASE
Type: SPECIAL INSPECTION
Subtype:
Status: ISSUED
Applied: 5/21/2015 MFA
Approved: 5/21/2015 MFA
Parcel No: 767630012 Site Address: 81739 RANCHO SANTANA DR LA QUINTA,CA 92253
Subdivision: TR 31202-1
Block:.
Lot: 12
Issued: 5/21/2015 MFA
Lot Sq Ft: 0
Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $0.00
Occupancy Type:
Construction Type:
Expired: 11/17/2015 MFA
No. Buildings: 0
No. Stories: 0
No. Unites: 0
Details: SPECIAL INSPECTION FOR METER RELEASE
CONDITIONS
Printed: Thursday, May 21, 2015 9:52:06 AM 1 of 2
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.,BOND INFORMATION
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