BSPN2015-0042LICENSED 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. 7031.5, 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 in 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 ofsale.).
(� 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
LIC. No.:
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 worl(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 rnot 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.SUBIECT 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. .
Signature (Applicant or Agent): ~-�
��
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS
(760) 777-7153
•
BUILDING PERMIT
Application Number: BSPN201S-0042
,� 4 ,
Owner:
Property Address: 55578 SOUTHERN HILLS
"��
NATIONSTAR MORTGAGE
APN: 775181074
Description: NATIONSTAR/IID RELEASE FOR METER
350 HIGHLANDDRApplication
LEWISVILLE, TX 92201Property
7/2
Zoning:
Application Valuation: $0.00Applicant:
Contractor:
BRANDY NELSON _ LISTING AGENT
41183 ROSDALE
INDIO, CA 92203
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. 7031.5, 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 in 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 ofsale.).
(� 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
LIC. No.:
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 worl(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 rnot 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.SUBIECT 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. .
Signature (Applicant or Agent): ~-�
l 1 . • l ,
DESCRIPTION .V ` _: *s � V"� 9 ACCOUNT ; f �i $ Tli h s AM`. NT ¢ 5 tip" S ` ,
6 q 4 # OU AID PAID"DATE
�. ...a,.. ;;:... f .?uis.:�?: w,...ae, "s.: `[^:. '8.: ."-n`-' x ,- r � «..c:. '�'d s 7;Y,; ?sI �z�Lt,'i
SPECIAL INSPECTION 101-0000-42404
40
` ' $72:52 $72.52
9/2/15
.
"Im
5.
METHOD
d"'�°. .k*,• g € s -�A;;r-��:ir;:-..rrrS a:-
REC EIPT # #
-rii.r�:. .
LTD BY
r' Ort
;CHECK 4
�,C
NELSON R.E. VENTRUES INC. CHECK'
R8934 5015
SKH
Total.Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTION:. '$72.52 , . $72:52 ;. '
ONSTAR / IID RELEASE FOR METER
Type: SPECIAL INSPECTION
Subtype: Status: UNDER REVIEW
Applied: 9/2/2015 SKH
Approved:
Parcel No: 775181074 Site Address: 55578 SOUTHERN HILLS LA QUINTACA 92253
Subdivision: TR 25500-1
- Block: 'Lot: 5
Issued:
Lot Scl 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
NATIONSTAR MORTGAGE
Details:. SPECIAL INSPECTION FOR III) RELEASE. PERMIT IS NOT FOR WORK. 2013 CALIFORNIA BUILDING CODES.-
Description: NATI
NAML'—k L11 -T. 1#V
NAME IYFL& 71,A P
APPLICANT
BRANDY NELSON - LISTING AGENT
41183 ROSDALE
INDIO
CA
92203- (866)516-6348
OWNER
NATIONSTAR MORTGAGE
350 HIGHLAND DR
LE WISVILLE.
TX
92201 (866)516-6348
Printed: Wednesday, September 02, 2015 3:36:04 PM 1 of 2- CRWIYSTIMS
.u� k.... <�:: :.Y ...E_42w Y y:•ay
'�. '.,i . ,1k .,., ♦
RETURNEDSTATUS`
REVIEW TYPE REVIEWER SENT DATE; °DUE DATE :
'�
BOND
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REMARKS w
'NOTES '
. y ,
REVIEWS
..
•
•
b�he✓ in-�j Iv�'tio..S�Ca�
Bin.#
Qty of LQ Quinta
Building a Safety Division
P.O. Box 1504,78-495 Calle Tampico
1.a.Quinta, CA 92253 -:(760) 777-7012
Building Permit ApPlication and Tracking Sheet
Permit #
Project Address:
Owner's Name:.
C
A- P. Number. -7 l
d
Address: . -
Legal Description:
City, ST, Zip: ( �- p1
Contractor
Telephone: - -
Address:
Project Description:
City, ST, Zip:
Telephone:
(SAAky
State Lic. #:
City Lie. #:
Arch., Engr., Designer
Address:
City., ST, Zip:
Telephone:
State Lic. #`.
Y
Construction Type:. Occupancy:
Project type (circle one): New Add'n Alter Repair
Demo
Name of Contact Person:
Sq. Ft.: 3 U1
# Stories: # Units:
Telephone # of Contact Person:
Estimated Valise of Project:
APPLICANT: DO NOT WRITE BELOW THIS UNE
0
Submittal
Req'd
Recd
TRACIS:ING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
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
Mechafikal
Grading plan
2'a Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN DOUSE:-
'^' Review; ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Coataet Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees