BELC2016-0103-
78-495 CALLE TAMPICO C� D ® OIC 760) 777 7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT F 60 77-7011
BUILDING PERMIT De OF��0?
RIO _ (76 7153
�F ate• 12 /2016
Application Number: 44
BELC2016-0103 Owner: n'
Property Address: 54966 SOUTHERN HILLS TSIUN TSE �FQ�U�/NTO'QATj,9
APN: 775120050 16154 AURORA CRESTD1i
Application Description: TSENG RESIDENCE / ELECTRICAL WHITTIER, CA 92253' yf/V
Property Zoning:2.
Application Valuation: $800.00
Applicant:
RANGEL INC -
P 0 BOX 14427
PALM DESERT, CA 92255
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
ense Class: 10 License No.: 753548
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 fle 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).:
(_J 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.).
(_J 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 Addres<
-
Contractor:
RANGEL INC
P 0 BOX 14427
PALM DESERT, CA 92255
(760)360-7377
Llc. No.: 753548
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.
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: PREFERRED EMPLOYERS INSURANCE COMPANY Policy Number:
WKN149261
r
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: ./Z/2G/!6 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.
1 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 -mention d property for inspection purposes.
Date:
�Z �Z 1P//6 Signature (Applicant or Agent): v
DESCRIPTION ACCOUNT AMOUNT
BSAS SB1473 FEE101-0000=20306 0
$1.00
Total_Paid for BUILDING STANDARDS ADMINISTRATION BSA:
DESCRIPTION
.ACCOUNT
'QTY
AMOUNT
APPLIANCES, RES
101-0000-42403
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCES, RES PC,�
101-0000-42600
0
$12.67
Total Paid for-ELECTRICAL: $25.34
DESCRIPTION
ACCOUNT '
QTY
AMOUNT
PERMIT ISSUANCE ',
101-0000-42404
0
$96.27
Bin #
City of La. Quinta
Building 8'r Safety Division
Permit # rI `(7� 78-495 Caffe Tampico
La Quinta, CA 92253 - (760) 777-701,2 -
Building Permit Application and Tracking Sheet .
Project Address: �� % H17 I Owner's Name:
A. P. Number:
Address: 5- q �p _,�U
Legal Description:
City, ST, Zip: 1141L- �j v, it C A I'a 2-S
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Contractor: . PiPh
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T ele y
ne: C:�
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Address: ��:3 �Cw vti'� �/ .w� �i .
Project Description:
City, ST, Zip: �''
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Tel
Telephone:
P
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State Lic. # : C - /d 1S1 -P16
City Lie-
7;i
Arch., Engr., Designer: /--fil-
Address:
City, ST, Zip:
Telephone: I •
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P
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aneY
Construction Type: Occupancy:
•
t •
State a L ic.
•
Alter
Demo type (circle one)! New Add'n
Repair
Name of Contact Person:
Sq. Ft.:
# Stories: I
# Units:
Telephone # of Contact Person:
Q =G
Estimated Value of Project: U 00
-
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Rcq'd
Rcc'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item.
Amount
Structural Caics.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construe 'OR '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical .
SubcontactorList
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
Jrd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P. ,
Pub. \1'ks- Appr
Date of permit issue
School Fees,
.
l
Total Permit Fees