BSPN2016-004478-495 CALLE TAMPICO,
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
SHOUP LEGAL
29995 TECHNOLOGY DR STE 101
MURRIETA, CA 92563
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
MFH PIERCE GROUP
838 SW 1ST AVE STE 210
INSPECTION PORTLAND, OR 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.:
Date:
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).:
(1 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 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 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 Address:
Contractor:
Llc. No.:
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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 polity 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.
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 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
above-mentioned property for inspection purposes.
Dat`, Signature (Applicant or Agent)
DESCRIPTION
FINANCIAL .1.
ACCOUNT QTY.
AMOUNT
PAID
PAID DATE
CASH OVER
101-0000-42300 0
$7.48
$7.48
6/6/16
PAID BY
METHOD
-RECEIPT:#
CHECK #
CLTD BY
SHOUP LEGAL
CHECK
R16005
1081
SKH
Total Paid for CASH OVER:
$7.48
.$7.48 '
DESCRIPTION
- A00OUNT ,
QTY
AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION
101-0000-42404
0
$72.52
$72.52
6/6/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
SHOUP LEGAL
CHECK
R16005
1081
SKH
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$72.52
$72.52
Description: MILLER / NEW BUSINESS INSPECTION
CHRONOLOGY
CONDITIONS
Type: SPECIAL INSPECTION Subtype:
Status: UNDER REVIEW
Applied: 6/6/2016 SKH
Approved:
Parcel No: 770151002 Site Address: 78060 CALLE ESTADO LA QUINTA,CA 92253
Subdivision: DESERT CLUB TR UNIT 1 Block: 10
Lot: 5
Issued:
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $0.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0'
SHOUP LEGAL
Details: NEW BUSINESS INSPECTION. THIS PERMIT IS NOT FOR WORK. 2013 CALIFORNIA BUILDING CODES.
MURRIETA
FINANCIAL
CHRONOLOGY
CONDITIONS
NAME TYPE -
.. ,. 'NAIVIt,,,
dbbktSSl
CONTACTS
CITY
$7.48
6/6/16 R16005 1081 CHECK SHOUP LEGAL SKH
Total Paid for CASH OVER: $7.48 $7.48
STATE
ZIP
PHONE
'FAX
EMAIL
APPLICANT
SHOUP LEGAL
29995 TECHNOLOGY
DR STE 101
MURRIETA
CA
92563
OWNER
MFH PIERCE GROUP
838 SW 1ST AVE STE
210
PORTLAND
OR
92253
FINANCIAL
INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
• � BY
CASH OVER 101-0000-42300 0 $7.48
$7.48
6/6/16 R16005 1081 CHECK SHOUP LEGAL SKH
Total Paid for CASH OVER: $7.48 $7.48
Printed: Monday, lune 06, 2016 1:13:00 PM 1 of 2
SYSTEnAS
PARENT PROJECTS
BOND INFORMATION
ATTACHMENTS
Printed: Monday, June 06, 2016 1:13:00 PM 2 of 2 C _
_ SYS7[ti1S
CBYDc
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID,
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
SPECIAL INSPECTION
101-0000-42404
0
$72.52
$72.52
6/6/16
R16005
1081
CHECK
SHOUP LEGAL
SKH
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$72.52
$72.52
TOTALS:$80.00
PARENT PROJECTS
BOND INFORMATION
ATTACHMENTS
Printed: Monday, June 06, 2016 1:13:00 PM 2 of 2 C _
_ SYS7[ti1S
Din #
Submittal
City of La Quinta
•Buifding &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: 76ocooC
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Owner's Name:
A. P. Number:
Q J%A*ot e- A CZ7- +3
Address: i 1 Uc
Legal Description:
City, ST, Zip: 6�dga 7-7
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telephone: �j0 Z q J
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Address: 00
Project Description:
City, ST, Zip: T ► W m
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Telephone.
Truss Calcs.
G 'MN
City Lie. #;
State Lic. # : -
Pian Check Balance
Arch., Engr., Designer:
Title 24 Calcs.
Address:
Plans picked up
City., ST, Zip:
Construction
Telephone:
State Lic. #:.`
Flood plain plan
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Construction Type: Occupancy:
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Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:#Stories:
# Units:
Telephone #,of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Clieck Deposit
Truss Calcs.
Called Contact Person
Pian 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
Pians picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
s"' Reylew, ready for correctionsAssue
Developer Impact Fee
=PlanningApP.COXat:_
Called C.ontat Person
_A,LI'.g.
_
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Pees