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BPLB2017-0035LICENSED CONTRACTOR'SDECLARATION 1 I hereby affirm under penalty of perjury that I am licensed under rovisions of Chapter 9 (commencing with Section 70001 of Division 3 of the B s nd Professions Code, and my License is in full force and effect. License Class: C36, B License No.: 598056 Dater TZ3 /11 Contractor: �r OWNER -BUILDER CLA I hereby affirm under penalty of perjury that I a empt 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 al 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.). ( ) 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 Lender's WORKER'S COMPENSATON DECLARATION I hereby affirm under penalty of perjury one oll the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 370C of the Labor Code, for the performance of th rfo ich this permit is issued. ave and will maintain workers' compensation insurance, as required by Sectior7i 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: MIDWEST EMPLOYERS CASUALTY COMPANY Policy Number: I certify that in the performance of -he work for which this permit is issued, 1 shall not employ any person in any manner so 3s to a suAct to the workers' compensation laws of California, and agree that,' I shout beefme subject to the workers' compensation provisions c Section 3 0 of the b Code, I shall forthwith WARNING: FAILURE TO SECURE WORKERS' COV17ENSATION 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 FOF IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to th-2 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 =ity 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 t(an'state ve in r at on is correct. I agree to comply with all city and county ordiranclaw r tat. g to building construction, and hereby authorize rel senta-:iveto r pon the above-mentied property for inspection purposeDa�gnature (Applicant it A VOICE (760) 777-7125 78-495 CALLE.TAMPICO V 1 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT FAX (760) 777-7011 INSPECTIONS (760) 777-7153 BUILDING PERMIT 017 Z w Application Number: BPLB2017-0035 Owner: Property Address: 78455 CALLE 0RENSE NANCY ADAMS Q APN: 646192012 LLJ ® Application Description: ADAMS / 100 LF OF GAS LINE FOR FIRE PIT 92253 o z Property Zoning: cNJ W Application Valuation: $1,500.00 M W O Applicant: Contractor: m _ CHARLES SCICLI & ASSOC INC � O Q U— C5 CHARLES SCICLI S ASSOC INC C 5 30400 VIA LAS PALMAS 30400 VIA LAS PALMAS � THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 9227 Z C7 ® (760)343-0399 0 Llc. No.: 598056 LICENSED CONTRACTOR'SDECLARATION 1 I hereby affirm under penalty of perjury that I am licensed under rovisions of Chapter 9 (commencing with Section 70001 of Division 3 of the B s nd Professions Code, and my License is in full force and effect. License Class: C36, B License No.: 598056 Dater TZ3 /11 Contractor: �r OWNER -BUILDER CLA I hereby affirm under penalty of perjury that I a empt 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 al 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.). ( ) 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 Lender's WORKER'S COMPENSATON DECLARATION I hereby affirm under penalty of perjury one oll the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 370C of the Labor Code, for the performance of th rfo ich this permit is issued. ave and will maintain workers' compensation insurance, as required by Sectior7i 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: MIDWEST EMPLOYERS CASUALTY COMPANY Policy Number: I certify that in the performance of -he work for which this permit is issued, 1 shall not employ any person in any manner so 3s to a suAct to the workers' compensation laws of California, and agree that,' I shout beefme subject to the workers' compensation provisions c Section 3 0 of the b Code, I shall forthwith WARNING: FAILURE TO SECURE WORKERS' COV17ENSATION 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 FOF IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to th-2 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 =ity 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 t(an'state ve in r at on is correct. I agree to comply with all city and county ordiranclaw r tat. g to building construction, and hereby authorize rel senta-:iveto r pon the above-mentied property for inspection purposeDa�gnature (Applicant it A Date: 2/23/2017 Application Number: BPLB2017-0035 Owner: Property Address: 78455 CALLE ORENSE NANCY ADAMS APN: 646192012 Application Description: ADAMS / 100 LF OF GAS LINE FOR FIRE PIT 92253 Property Zoning: Application Valuation: $1,500.00 Applicant: Contractor.. CHARLES SCICLI & ASSOC INC. CHARLES SCICLI.9 ASSOC INC 30400 VIA LAS PALMAS 30400 VIA LAS PALMAS THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276 (760)343-0399 Llc. No.: 598056 Detail: PLUMBING - 10OLF OF GAS LINE FOR FIRE PIT PER APPROVED PLAN. 2016 CALIFORNIA BUILDING CODES. DESCRIPTION • ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, -,1-4 OUTLETS 101-0000-42401 0 '$12.67 - DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 1-4 OUTLETS PC 101-0000=42600 0 $25.33' - Total Paid for PLUMBING FEES: $38.00 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 r r - — woo'seleloossypueilolosselieyo@saueyo 9LZZ6 do'SW!ed puesno41. d al!ns •laailS al04S WON 890ZL 86£0'£ti£'09L :Xed 66£0'£b£'09L "I"O luawd019n8a • Bugoejluoo jejauaE • 6uigwnld Pos saijeyo , '3ut' Isa;ni.7055y pq:)s sal.rb yD • 9SOBBS'�!l / �� ,a LOSS CILA QUID PA B & SAi=�ETD L:D�NG ONST', CTION- 422/ IAOJ �1 ` 001 �o�'I b -Zi fill C IN Bin #Qty Permit #/ IP-roject Address: of La Qcry► to Building 8z: Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet . C*1Q 01&1�� t wner's Name:Eu" 0440-"d, A. P. Number: JAddress�7� T l(e 0,-&C Fe Legal Description: > City, ST, Zip: IA— at. K "— !=. ntra Co ct r: o r r- u .G �� h nc: Tele o C�'J P O :ddress: 71, Oft A44i(A4 ',4 F-�n- rPr''oject Description: �y, ST, Zip: Afi�j ` 4 's -%b /� bole, e• Fel hon . f► e P v Zs Ys 1 State Lic. # : �(f �'`Ciry Lic. #: �UQ Z b lt7 Arch.,'Engr., Designer: Address: City, ST, Zip: Telephone: .. Occupancy: CPane :an tructi n Type: Lic. #. Add'n Alter Repair.air Demo oStato Pr JecttYP (circle one : New Nme of Contact Person: id Sq. Ft.: # Stories: # Units: ele hone # of Contact Person: t )T-' p �f<QQ ' r— y % �. a ' Estimated Value of Project: APPLICANT: DO. NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'.d TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cafes. Reviewed, ready for corrections Plan Check Deposit Truss Calcs.. Called Contact Person Plan Check Balance.. Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2pd Revicw, 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 I-TOUSE:- 7rd Reyiew, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person Pub. \Vks. Appr Dale of permit issue School Fees, I ` Total Permit Fees