BELC2017-004278-495 CALLE TAMPICO C� aW VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT ` INSPECTIONS (760) 777-7153
BUILDING PERMIT
o Dat e-- ....... �17
Application Number: BELC2017-0042 Owner:
Property Address: 77600 CALLE TECATE ROBERT H STAVERS n s
APN: 774302022 77600 CALLE TECATE ren D
mOF
Application Description: STAVERS / (1) RECEPTACLE IN GARAGE LA QUINTA, CA 92253 0
Property Zoning:
Application Valuation: $250.00 0 �I
M
9
Applicant: Contractor:
M L;
SOLAR RENEWABLE ENERGY SOLAR RENEWABLE ENERGya
3421 BERNARDINO LN 3421 BERNARDINO LN
VISTA, CA 92084 VISTA, CA 92084
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: C10, C46 License No.: 990943
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).:
( ) 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 Name:
Lender's Address:
(760)805-4664
Llc. No.: 990943
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.
1 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9103052
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 thos provisions.
f
Date: " S 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: S Signature (Applicant or Agerrtl _ ' -
FINANCIALI•• •
:DESCRIPTION ACCOUNTQTY
AMOUNT
BSAS SB1473 FEE 101-0000-20306 0
$1.00.
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
' ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION '
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
W Total Paid for ELECTRICAL: .$50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27
Total Paid for PERMIT ISSUANCE. $96.27
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid.for TECHNOLOGY ENHANCEMENT FEE:. $5.00
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TOTALS:
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Bin #
�... .City of La Quiets '
Buifding &r Safety Division
Permit 78-495 Calle, Tampico -
�� r (1 n. j/► ^ ��j La Quinta, CA 92253 - (760) 777-701,2
'Building Permit Application and Tracking Sheet
Project Address: �W� C ffQ < f G C Owner's Name: RO
A. P. Number:
Address: jZ�j C �e l�Ca
Legal Description:
City, -ST, Zip: L'57 tt( 4-Z 2 2�
Contractor:
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.Address: 2'
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Project Description: .
City, ST, Zip: SL r� �� / CJ `T
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:City
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Lic. # : ��
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Arch.,
., )✓ngr., Designer:
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Address:
City, ST, Zip:
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T ele h ne:
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Cons tructi n Type: Occupancy:
State Ltc .# •
type one • New Add'n Alter Repair r De m 0
ProJeethP
Name of Contact Person:
Sq. Ft.:
#Stories:
# Units:
Telephone # of Contact Person:
'
Estimated Value of Project: 2 S�
y
APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd
Rcc'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 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 MOUSE:-
Review, ready for corrections/issuc
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fee's
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