BSPN2017-004878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
SPECIAL INSPECTION/
BSPN2017-0048
78740 AVENIDA TUJUNGA
770092013
MARMER / UTILITY RELEASE
Applicant:
JEFF MARMER
78740 AVENIDA TUJUNGA
LA QUINTA, CA 92253
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9
{commencing with Section 700 0) 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.l 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 ofthe 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
s'7,+-,��cts the applicant to a civil penalty of not more than five hundred dollars ($500).:
(� 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure isnot 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
C tractors' State License Law.).
I am exempt under Sec. B.&P.C. for this reason
'tO�ner:
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
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
EMANUEL MARMER
92253
Contractor:
Date: 10/31/2017
Llc. No.:
WORKER'STOMPENSATION 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: _ Polity 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.
Date: 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. ✓
Datef / 31 117 Signa ture•(Applicant or Agent):
01
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Llc. No.:
WORKER'STOMPENSATION 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: _ Polity 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.
Date: 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. ✓
Datef / 31 117 Signa ture•(Applicant or Agent):
01
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $78.02
DESCRIPTION'
ACCOUNT
QTY
r AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
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PERMIT#
PLAN LOCATION
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Project Address: ,
Pro ect Description: Pool, Remodel Add't Elect,.Plumb, Mech
APN #:
Garage SF
Telephone:
Patio/Porch SF.
Applicant Name: J M / (X M F%'�,
Fire Sprinklers SF
Address: 7V (f CD Ve,4(4 Ll 3 u h G /9
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City, ST, Zip: Q V I Vl t !�
Telephone: s"3 0 . U,
Email: 1 /�i 0i"A Prl
Contractor Name:
New SFD Construction:
Address:
Conditioned Space . SF
City, St, Zip
Garage SF
Telephone:
Patio/Porch SF.
Email:
Fire Sprinklers SF
State Lic: City .Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip 1
Construction Type:.. Occupancy:
Telephone:
Bedrooms:.
Stories:
#Units:.
Email:
State Lic: City Bus Lic:
Owner's Name: ve- L . M
New. Commercial / Tenant Impi ovements:
Address: 7e7( -"v eek (/)A 11S v"kf
Total Building SF
City, ST, Zip /1� 17 �A . Com' 9' ZZ,$ 3
Construction Type:.. Occupancy:
Telephone:. s J S !
Email: J V; a r �i f�