BRES2016-0372LICENSED CONTRACTOR'S DECLARATION. WORKER'S COMPENSATION DECLARATION - "
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance
License CL iss- B License No.: 944325 ofth wWorkim which this permit is issued.
LI have and will maintain workers' compensation insurance, as required by
Date: Contractor Leo, A 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:
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 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)•:
(_) [,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, 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:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9168769
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-tPc1ab9gCode, I shall forthwith
comply w' h those provisions.
Dart e:: AppIica4. `
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 stat laws relating to building
construction, and hereby authorize representatives of this ci o enter u on the
above -me ione property for inspection purposes.
Date Signature (Applicant or Agent
VOICE (760) 777-7125
78-495 CALLE TAMPICO
FAX (760) 777-7011
LA QUINTA, CALIFORNIA
92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/25/2017
Application Number:
BRES2016-0372
Owner:
Property Address:
61763 TOPAZ DR
ROBERT REDLINE
APN:
76453.0.02l.-.
246 SILAS LN
Application Description:
REDLINE / ATTACHED CASITA AND COVER ENTRY AT EXISTING HOME
NEWBURY PARK,'CA 9
Property Zoning:.
Application Valuation:
$46,000.00
f-
Applicant:
Contractor:
x
a
J o
ALBERTO DAZA
DAZ' -
a ,
P.O. BOX 5083
P.O BOX 5083
�. g i
LA QUINTA, CA 92247LA
QUINTA, CA 92
z o
(760)285-3793
Q v�
a
Llc. No.: 944325
LICENSED CONTRACTOR'S DECLARATION. WORKER'S COMPENSATION DECLARATION - "
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations:
9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, I have and will maintain a certificate of consent to self -insure for workers'
and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance
License CL iss- B License No.: 944325 ofth wWorkim which this permit is issued.
LI have and will maintain workers' compensation insurance, as required by
Date: Contractor Leo, A 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:
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 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)•:
(_) [,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, 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:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9168769
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-tPc1ab9gCode, I shall forthwith
comply w' h those provisions.
Dart e:: AppIica4. `
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 stat laws relating to building
construction, and hereby authorize representatives of this ci o enter u on the
above -me ione property for inspection purposes.
Date Signature (Applicant or Agent
Date:
..
w .
.1/25/2017,
Application Number:
BRES2016-0372
Owner:
Property Address:
61763.TOPAZ DR
ROBERT REDLINE
APN:
764530021
246 SILAS LN
Application Description:
`REDLINE / ATTACHED CASITA AND COVER ENTRY AT EXISTING HOME
NEWBURY PARK, CA 92253.:
Property Zoning:
Application Valuation:
$46,000.00
Applicant:
Contractor:'
ALBERTO DAZA
DAZ
P.O. BOX 5083
P O BOX 5083
LA QUINTA, CA 92247
LA QUINTA, CA 92253
'
(760)285-3793 .
"
Llc. No.: 944325
Detail: 308 SQ. FT. ATTACHED CASITA WITH 86.8 SQ. FT. PATIO ADDITION PER 2013 CRC CODES. CASITA NOT FIRE SPRINKLED.
JINANCIAL •• •
DESCRIPTION ACCOUNT 'CITY AMOUNT
ADDITION, EA ADDITIONAL 500 SF. 101-0000-42400 0 $65.36
DESCRIPTION ACCOUNT CITY AMOUNT.
ADDITION, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $18.24
DESCRIPTION ACCOUNT CITY AMOUNT
ADDITION, FIRST 100 SF 101-0000-42400 0 $127.68
DESCRIPTION ACCOUNT CITY AMOUNT
ADDITION, FIRST 100 SF PC 101-0000-42600 0 $179.36
Total Paid for ADDITION: $390.64
DESCRIPTION
ACCOUNT
CITY
AMOUNT
BSAS SB1473 FEE
101-0000-20306
0
$2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
CITY .
AMOUNT
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$152.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT .
M
RESIDENTIAL, FIRST 1,000SF, PC ..
101-0000-42600
0
$50.16
Total Paid for ELECTRICAL - NEW CONSTRUCTION: $202.16
DESCRIPTION
ACCOUNT
CITY
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600
0
$25.33
DESCRIPTION
ACCOUNT
CITY
AMOUNT
FURNACE
101-0000-42402
0
$38.00
DESCRIPTION
ACCOUNT•
CITY
AMOUNT
FURNACE PC
101-0000-42600
0
$25.33.
DESCRIPTION
ACCOUNT
CITY
AMOUNT
VENT FAN
101-0000-42402
0
$12.67
DESCRIPTION
ACCOUNT
CITY,
AMOUNT
VENT FAN PC
101-0000-42600
G.
$5.07
Total Paid for MECHANICAL: $144.40
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-424.01
0
$50.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT i
FIXTURE/TRAP PC
101-0000-42600
0
$50.68
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
CITY
AMOUNT
WATER SYSTEM INST/ALT/REP PC .
101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: $126.70
DESCRIPTION
ACCOUNT
CITY
AMOUNT