BELC2016-0077x
78-495 CALLE TAMPICO D .NMU�
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2016-0077
Property Address: 55491 SOUTHERN HILLS
APN: 775200020
Application Description: VAUGHN / ELECTRICAL FOR BBQ
Property Zoning:
Application Valuation: $860.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
VAUGHN
55491 SOUTHERN HILLS
LA QUINTA, CA 92253
Applicant:
Contractor:
TOP PROJECT POOL CONSTRUCTION
TOP PROJECT POOL CONSTRUI
67782 E PALM CANYON DRIVE
67782 E PALM CANYON DRIVE
STE B104 #128
STE B104 #128
CATHEDRAL CITY, CA 92234
CATHEDRAL CITY, CA 92234
(760)778-9964
Llc. No.: 1016165
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: C53 ( License No.: 101616YDLAJX�A�n(QN Date: �' �` < Contractor:OWNER-BUILDERI hereby affirm under penalty of perjury that I am amot
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:
Date: 9/9/2016
WORKER'S COMPENSATION DECLARATION
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hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure fqr 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 370Qof a Labor Code, for the performance of the work for which this permit
s issued. wor • rs' compensation insurance carrier and policy number are:
Carrier: EX 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, and agree that, if I ou become subject to the
workers' compensation provisions of Section 370 of the La or de; I all forthwith
comply with those provisions.
Date: Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPEN ATION 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 be 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
above-mentioned property for inspection purposes.
Date: r Signature (Applicant or Agent):
'
Date: 9/9/2016
Application Number: BELC2016-007.7
Owner:
Property Address: 55491 SOUTHERN HILLS
VAUGHN
APN: 775200020
55491 SOUTHERN HILLS
Application Description: VAUGHN / ELECTRICAL FOR BBQ
LA QU,INTA, CA 92253
Property Zoning:
Application Valuation:- ' $860.00
. Applicant
Contractor:
TOP PROJECT POOL CONSTRUCTION
TOP PROJECT POOL CONSTRUCTION
67782 E PALM CANYON DRIVE
67782 E.PALM CANYON DRIVE
STE B104 #128
STE B104 #128
CATHEDRAL CITY, CA 92234
CATHEDRAL CITY; CA 92234
(760)778-99.64
Llc. No.: 1016165
Detail: ELECTRICAL FOR BBQ. 2013 CALIFORNIA BUILDING CODES.
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...FINANCIAL INFORMATION.
DESCRIPTION ACCOUNT CITY.
AMOUNT
=BSASSB1473FEE 101-0000-20306 0
$1.00
Total Paid for, BUILDING STANDARDS ADMINISTRATION BSA: $1.00.
DESCRIPTION
ACCOUNT
CITY
AMOUNTf
:. DEVICES, FIRST 20
101-0000-42403
0
$24.17
DESCRIPTION
-ACCOUNT
CITY ,
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$24:17
Total Paid for ELECTRICAL: .$48.34
.DESCRIPTION
ACCOUNT •
AMOUNT
PERMIT ISSUANCE
101-0000-42404
!CITY
0
$91.85
Southern Hills