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BPLB2016-0062a 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT I hereby affirm under penalty of perjury one of the following declarations: BUILDING PERMIT Application Number: BPLB2016-0062 Owner: Property Address: 80944 BELLERIVE JAMES ELLIOTT APN: 775350005 Application Description: CHRISTENSEN / GAS LINE FOR POOL 92253 Property Zoning: OWNER -BUILDER DEC RATION Application Valuation: $400.00 Applicant: BRIAN WESTLAKE LANDSCAPE INC P 0 BOX 5175 LA QUINTA, CA 92248 Contractor: VOICE.(760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BRIAN WESTLAKE LAN P 0 BOX 5175 LA QUINTA, CA 92248 (760)250-2924 Llc. No.: 857801 Date: 4/7/2016 7 2010 CITYOFLAQUINTA LICENSED CONTRACTOR'S DECLARATION I WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations: 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers' and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance License Class: C27 License No.: 857801 fAer oft ork for which this permit is issued. LA-Yhave and will maintain workers' compensation insurance, as required by Cate.? . Cont�a or: Se ion 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: OWNER -BUILDER DEC RATION Carrier:- Polity Number: _ I hereby affirm under penalty of perjury that I a exempt from the Contractor's State I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair compensation laws of California, and agree that, if I should become subject to the any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith signed statement that he or she is licensed pursuant to the provisions of the comply with those provisions. Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 Business // A/ i L ` 4 of the and Professions Code) or that he or she is exempt therefrom and the I Date: Applicant: i 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 WARNING: FAILURE TO SECURE WORKERS' CO PENSATION COVERAGE IS UNLAWFUL, ($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO (_) 1, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF compensation, will do the work, and the structure is not intended or offered for sale.' COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application. he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose (_) I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit to construct the project. (Sec..7044, Business and Professions. Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or the Contractors' State License Law.). following issuance of this permit. (� I am exempt under Sec. B.&P.C. for this reason 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. 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 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 property for inspectio Date: [e-AP71, 16 Signature (Apr f .• !. FINANCIAL :.DESCRIPTION _ ACCOUNT . QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 4/7/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY . BRIAN WESTLAKE LANDSCAPE INC DEBIT R14581 RSE Total.Paid for BUILDING STAN DARDS. ADMINISTRATION BSA: .$1.00.. $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 4/7/16 PAID BY METHOD RECEIPT # _ -CHECK # CLTD BY BRIAN WESTLAKE LANDSCAPE INC DEBIT R14581 RSE Total Paid for PERMIT ISSUANCE: $91.85 $91.85 DESCRIPTION A00OUNT QTY: AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $12.09 $12.09 4/7/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY BRIAN WESTLAKE LANDSCAPE INC. DEBIT R14581 RSE DESCRIPTION ACCOUNT QTY ' AMOUNT PAID PAID DATE GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $24.17 $24.17 4/7/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY BRIAN WESTLAKE LANDSCAPE INC DEBIT R14581 RSE Total Paid for PLUMBING FEES: $36.26 $36.26 Description: CHRISTENSEN / GAS LINE FOR POOL Type: PLUMBING Subtype: Status: UNDER REVIEW Applied: 4/7/2016 RSE Approved: Parcel No: 775.350005 Site Address: 80944 BELLERIVE LA QUINTA,CA 92253 Subdivision: TR 28961 Block: Lot: 5 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $400.00 Occupancy Type: Construction Type: Expired; No. Buildings: 0 No. Stories: 0 No. Unites: 0 _u.-....... ADDRESSl CITY Details: 30 LF OF VGAS LINE FOR POOL EQUIPMENT. 2013 CALIFORNIA BUILDING CODES. APPLICANT FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 4/7/16 R14581 DEBIT BRIAN KE LANDSCCAPEAPE INC RSE Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: Printed: Thursday, April 07, 2016 9:25:11 AM 1 of 2 SYSTCMS ADDITIONAL CHRONOLOGY CONDITIONS CONTACTS TYPE ' ° "'" �� NAME'I�Ailll _u.-....... ADDRESSl CITY STATE ZIP PHONE FAX EMAIL APPLICANT BRIAN WESTLAKE LANDSCAPE INC P 0 BOX 5175 LA QUINTA CA 92248 . CONTRACTOR BRIAN WESTLAKE LANDSCAPE INC P 0 BOX 5175 LA QUINTA CA 92248 OWNER JAMES ELLIOTT 92253 FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $1.00 4/7/16 R14581 DEBIT BRIAN KE LANDSCCAPEAPE INC RSE Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00 BSA: Printed: Thursday, April 07, 2016 9:25:11 AM 1 of 2 SYSTCMS INSPECTIONS Printed: Thursday, April 07, 2016 9:25:11 AM 2 of 2 SYS TEti1S CLTD DESCRIPTION ACCOUNT • QTY AMOUNT PAID PAID DATE RECEIPT# CHECK # METHOD PAID BY BY PERMIT ISSUANCE 101-0000-42404 0 $91.85 $91.85 4/7/16 R14581 DEBIT BRIAN WESTLAKE RSE LANDSCAPE INC Total Paid for PERMIT ISSUANCE: $91.85 $91.85 GAS SYSTEM, 1-4 101-0000-42401 0 $12.09 $12.09 4/7/16 • R14581 DEBIT BRIAN WESTLAKE RSE OUTLETS LANDSCAPE INC GAS SYSTEM, 1-4 101-0000-42600 0 $24.17 $24.17 4/7/16 R14581 DEBIT BRIAN WESTLAKE RSE OUTLETS PC LANDSCAPE INC Total Paid for PLUMBING FEES: $36.26 $36.26 TOTALS: $129.11 $129.11 INSPECTIONS Printed: Thursday, April 07, 2016 9:25:11 AM 2 of 2 SYS TEti1S Po n RECEIVED CITY OF LA QUINTA COMMUNITY DEVELOPMENT x, I 0 rl EQ -gyp Bin #' City of La Quinta Building ST Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: ��(� C Owner's Name: t` �US �✓�S'P�� A. P. Number: Address: �o ��{!.� I l ey-1 Legal Description: City, ST, Zip:v G� G� 1 C oc Z Contractor: ��.TeleP G hone: ...........::....:.........:...:::::::::::::: Address:i C) 90)(, �( •7' ( 4 Project Description: L City, ST, -Zip: ` VIq?,p C ( Z Gln �3(�S l ►'� l_ oc 1 T n cle h e. Po L a Z 7 Sa Z�1 L State Lic. #: 5 � gU � � : City Lie ..#.: f �l � 0 C 4 �} Arch., Engr., Designer: Address: City., ST, Zip: Telephone: - _ Cons n TYe: Occupancy: P : Sa t to Lic. #• Project a (circle one New dd'n J h'P � )• e A Alter Re air Demo A Name of Contact Person: (� �/es7'�C[ Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: 76 a L so Z I Z Lt I Estimated Value of Project: UCS APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction Floodplain 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. II.O.A. Approval Plans resubmitted Grading IN HOUSE:- Jrd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees, Total Permit Fees