BSPN2016-005078-495 CALLE TAMPICO . D VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Application Number:
BSPN2016-0050
Owner:
Property Address:
52190 AVENIDA JUAREZ
PHILIP NATWICK
APN:
773211008
Application Description:
RW REAL ESTATE INC / IID RELEASE
Property Zoning:
Application Valuation:
Applicant:
D
Contractor:
RW REAL ESTATE INC
2 7.N16
P 0 BOX 447
�uN
LA QUINTA, CA 92247`
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Aau(N_
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om of qui :�rhl
1�'�KhU11fTY DEVELOP�dEN'�N
.
Llc. No.:
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.S, 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).:
pI, as owner of the property, or my employees with wages as their sole
compensation,
pensation, will do the work, and the structure its 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 C. for this re on
Date: -14 LQ Owner:
CONSTRUCTION LENDING AGE
I hereby affirm under penalty of perjury that there is a conruction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
Date: 6/27/2016
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:_ 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, andagree , if I should b me subject to the
workers' compensation provisions of
Se on 3700 of the Labor ode, l shall forthwith
comply with those provisions.
Date:/elICV Applicant:
Q,,�—
WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO(706OFTHELABORCO
RAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIECIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDIT THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIONDE,
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 above inf mation is correct.
I agree to comply with all city and county ordinances nd state laws r lating to building
construction, and hereby authorize representatives of this city to ent r upon the above-
mentioned property for inspection purposes.
Date: ignature (Applicant or Agent
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT
QTY AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION
101-0000-42404
0 $72.52
$72.52
6/27/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
RW REAL ESTATE INC
CHECK
R16603
3926
RSE
DESCRIPTION
ACCOUNT
QTY
-AMOUNT
PAID
PAID DATE'
SPECIAL INSPECTION PC
101-0000-42600
0
$181.29
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $253.81 $72.52
Description: RW REAL ESTATE INC / IID RELEASE
FINANCIAL
.•,
Type: SPECIAL INSPECTION Subtype:
Status: UNDER REVIEW
Applied: 6/27/2016 RSE
Approved:
Parcel No: 773211008 Site Address: 52190 AVENIDA JUAREZ LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA VALE LA QUINTA Block: 5
Lot: 15
Issued:
UNIT 1
6/27/16 R16603 3926 CHECK RW REAL ESTATE INC RSE
SPECIAL INSPECTION PC 101-0000-42600 0
•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
Details: IID RELEAS. THIS JOB CARD IS NOT FOR ANLKY WORK.
Printed: Monday, June 27, 2016 10:42:42 AM 1 of 2
FINANCIAL
.•,
DESCRIPTION ACCOUNT QTY
AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
SPECIAL INSPECTION 101-0000-42404 0
$72.52
$72.52
6/27/16 R16603 3926 CHECK RW REAL ESTATE INC RSE
SPECIAL INSPECTION PC 101-0000-42600 0
$181.29
$0.00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
TOTALS:
$253.81
$2S3.81
$72.52
$72.52
Printed: Monday, June 27, 2016 10:42:42 AM 1 of 2
Permit Det►aI�S PERMIT NUMBER
City of La Quinta BSRN2a16-0050
. e
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES
DATE
Printed: Monday, June 27, 2016 10:42:42 AM 2 of 2 . 0-Zr7 '[_'/[!!/ _...__ . _
`n
City of La Quinta
Building 8I Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
-B bs,'D -Building Permit Application and Tracking Sheet
Permit#{
QIJ 2CD1 b
Project Address: t�21q0 PM em\
Owner's Name: 1 ��
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
^—� —•� O a
n 1 �G
Telephone
ele o e.
P
Address:
Project Description:
City, ST, Zip:
ne•
TeleP ho .
State Lic. # :
City Lie.
'Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
..........................:............................
n tru ction Type: Occupancy:
:
State Lic. #•
'e
P ro ct a circle one): New Add'n Alter J
h' �) A r ReP air Demo
P
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan
Plan Check submitted
Item
mount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
. Called Contact Person
Plan Check B ice
Title 24 Cales.
lans picked up
C ruction
Flood plain plan
Plans re mitted
Mechanical
Grading plan
tad Review, ready orrections/iss
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans bmitted
Grading
IN HOUSE:-
<Review, ready for corrections/issue
Dc er Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr_
Date of permit issue
School Fe ,
Total Permit Fees