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BSPN2016-006078-495 CALLE TAMPICO LA gUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BSPN2016-0060 Property Address:" 78685 SAGEBRUSH AVE' APN: 646311018 Application Description: LUCIAN.O MONTEZ /SPECIAL INSPECTION GAS Property Zoning: Application Valuation: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: JACQUELINE FRANCK 1052 SPLIT RAIL ST HENDERSON, NV 92253 Applicant: Contractor: LUCIANO MONTEZ ' 80948 SONGBIRD INDIC, CA 92201 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70001 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 t 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 Ac'. as owner of the property, or my employees with wages as their sole ensation, will do the work, and the structure is not intended or offered for sale.(ec. 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 In or she did not build or improve for the purpose of sale.). 1, as owner of the property, am exclusively contracting with licensed contractors Xto- nstruct 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 11�hh�e Contractors' State License Law.). 7W-Mam exempt under Sec. . B.&P.C. for this reason Date: 0q-6 J 14., ..Own _ OW �_ ► C/ URI LENDING AGENCY I hereby affirm under penal hof perju that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lendees.Name: Lender's Address:_ Llc. No.: Date: 9/1/2016 D Q 0 5�7 ©1 20 IS CITY0FLAQUIIITA. COhiA9UfdITYD�IF!r,P1�iEhJTDFF',Rii,ierJT I .' • 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 ork for which this permit is issued. >g- I have and will maintain workers' compensation insurance, as required by Sectir, 3700 of the' Labor Code, for the Performance of the'work for which this permit is iss ed. 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. ' 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. Date:,6t! -E9 /—/6 5ignatu a (Appl cah- o Agp , F LbLa Date: '9/l/2016 Application Number: BSPN2016-0060 Owner: Property Address: 78685 SAGEBRUSH AVE JACQUELINE FRANCK APN: 646311018 1052 SPLIT RAIL ST Application Description: LUCIANO MONTEZ / SPECIAL INSPECTION GAS HENDERSON, NV 92253 Property Zoning: Application Valuation: Applicant: Contractor: LUCIANO MONTEZ 80948 SONGBIRD INDIO, CA 92201 LIC. No.: Ui-n it"THIS JOB CARD IS FOR SPECIAL INSPECTION FUR GAIT RELLAS ONLY. NOT. FOR ANY WORK TO•BE DONE. 2013 CALIFORNIA BUILDING CODES: - ' �a DESCRIPTION ACCOUNT CTY AMOUNT SPECIAL INSPECTION 101-0000-42404 0 $72.52 DESCRIPTION ACCOUNT CTY AMOUNT SPECIAL INSPECTION PC 101-0000-42600 0 $181.29 Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECT'ON: $253.81 ' �a Bin l# .'c a Permit ## 1 Project Address:, _ a. Qty of La Quilita " Building 8z• Safety Division 78-495 Calfe Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Owner's Name: �N A. P. Number: �� , Address: Legal Description: City, ST, Zip:�N��0 q Contractor: ` T)AviL S Telephone:hone: - Address: �� — 5 a O I v N S'f Project Description: City --ST, Zip: Cd eG(a 3� / G' f Telephone: hone: a— D 5 oZ State Lic. # : — City Lic. #t Arch.,'Engr., Designer: Address: City, ST, Zip: Telephone: MENEM • Construction TYP e• O ecuP ane Sta.te Lic # •ProJect Re ai Demo type (circle: one): New Add'n Alter Name of Contact Person: Sq. Ft.: 756 # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: dao 6' APPLICANT: DO NOT WRITE BELOW THIS LINE tl Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cates. 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. Ii.O.A. Approval Plans resubmitted Grading IN HOUSE.:- 'rd 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