BSPN2017-004378-495 CALLE TAMPICO . C� 0 D VOICE (760) 777-7125
FAX (760).777-71311 "
LA QUINTA, CALIFORNIA 92253. DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 10/2/2C17
Permit Type/Subtype: SPECIAL INSPECTION/ Owner:
Application Number: BSPN2017-0043 ROBERT-LEOTAUD
Property Address: 54120 AVENIDA VALLEJO 1940 SOUTH GROVE AVE
APN: 774213026 ONTARIO, CA 91761
Application Description: LEOTAUD / ELECTRIC SAFETY METER RESET
Property Zoning:
Application Valuation: $0.00
Applicant: Contractor:
ROBERT LEOTAUD
1940 SOUTH GROVE AVE OCT Q 2 2���
ONTARIO, CA 91761
CITY OF LA OUNTA
DESIGN AND DEVELOPMENT DEPARTMENT Llc. No.:
=---------------------------------------------------------------------------------------------.
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 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.).
IS 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.).
Yl am exempt under Sec. B.&P.C. for this reason
at'e31 b 02 ZO l'� r �,vne�°
CONSTRUCTION DING 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:
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.
1 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 perm t is
issued. My workers' compensation insurance carrier and policy number are:
Carrier- ``_ Policy Number: _
-3 J I certify that in the performance of the work for which this permit is issued! I
shal�employ any.person in any manner so as to become subject to the workers'
compensation laws of California, and agree that, if l should become subject to the,
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
�I7�pnt
WARNFASE WORKERS�COM' PENSATI COVERAGE IS UNLAWFU'-,
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 COD =,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building. Official for permit subject -o
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 iss.ied
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 buildir.:g
construction, and hereby authorize representatives of this city to enter upon the abo%e-
mentioned property for inspection purposes.
Date:g 2 2 1'1 Si natrir tr Agents:
t
;;:.,;DESCRIPTION
FINANCIALI INFORMATION
ACCOUNT
QTY
AMOUNT
SPECIAL INSPECTION
101=0000-42404
0
$78.02
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:.
$78.02
DESCRIPTION
ACCOUNTQTY.
AMOUNT
Credit Card Fee
101-0000-43505
0
Total Paid for Credit Card'Fee:
$1.49
DESCRIPTION
ACCOUNT- ;
QTY
AMOUNT.
TECHNOLOGY ENHANCEMENT FEE.
502-0000-43611
0
$5.00
t
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City of La Quinta
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
160'y3 Building Permit Application and Tracking Sheet
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Construction Type:
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State Lic. #:.
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Name of Gonta`ct:
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Estimated Value of Project:
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Submittal
Req'd
Rec'd
TRACKING
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
Mechanical:
Grading Plan
2nd Rev, Ready fdr corrections/
Electrical:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading .
IN-HOUSE
3rd Rev, Ready for corrections./
Developer Impact Fee
Planning Approval
Called Contact.Person
A.I.P.P.
Pub. Wks. Apps
Date of permit issue
School Fees
Total Permit:Fecs. •:-.
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