BSPN2016-004978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
MELISA ANDERSON
79055 LADERA DR
LA QUINTA, CA 92253
1
BSPN2016-0049
79045 LADERA DR
U Xfv VOICE (760) 777-7125
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/24/2016
Owner:
JACK MALLORY
604271033 7904S LADERA DR
MELISA ANDERSON / IID RELEASE LA QUINTA, CA 92253
F2 4 2016. Contractor:
Y0 LAOUINTA
EVELOPMENT DEPARTMENT
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.).
( ) 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
Lender's Add
Llc. 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 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: _ 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 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.
Date: Signature (Applicant or Agent):
DESCRIPTION '
FINANCIAL INFORMATION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION
101-0000-42404
0
$72.52
$72.52
6/24/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
MELISA ANDERSON
CHECK
R16554
5015
RSE
DESCRIPTION
ACCOUNT •
QTY
AMOUNT
PAID.
PAID DATE
SPECIAL INSPECTION PC
101-0000-42600
0
$181.29
$0.00
PAID BY
METHOD,
RECEIPT #
CHECK #
CLTD BY
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$253.81
$72.52
Description: MELISA ANDERSON / IID RELEASE
CONDITIONS
CONTACTS
Type: SPECIAL INSPECTION
Subtype:
Status: APPROVED
Applied: 6/24/2016 RSE
Approved: 6/24/2016 RSE
Parcel No: 604271033 Site Address: 79045 LADERA DR LA QUINTA,CA 92253
Subdivision: TR 29624
Block:
Lot: 7
Issued:
Lot Sq 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
Details: IID ELECTRICAL RELEASE. THIS JOB CARD IS NOT FOR ANY WORK.
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE
NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL
APPLICANT
MELISA ANDERSON 79055 LADERA DR LA QUINTA CA 92253
OWNER
JACK MALLORY 79045 LADERA DR LA QUINTA CA 92253
Printed:. Friday, June 24, 2016 8:46:31 AM 1 of 2
SYS7EtitS
FINANCIAL
INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
PAID
PAID DATE RECEIPT# CHECK # METHOD PAID BY CLTD
-BY
SPECIAL INSPECTION 101-0000-42404 0 $72.52
$72.52
6/24/16 R16554 5015 CHECK MELISA ANDERSON RSE
SPECIAL INSPECTION PC 101-0000-42600 0 $181.29
$0.00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $253.81 $72.52
•
Printed:. Friday, June 24, 2016 8:46:31 AM 1 of 2
SYS7EtitS
INSPECTIONS
REVIEWS
--F
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS - REMARKS" NOTES
DATE
Printed: Friday, June 24, 2016 8:46:31 AM 2 of 2 srsTEMS
BOND
INFORMATION
ATTACHMENTS
Printed: Friday, June 24, 2016 8:46:31 AM 2 of 2 srsTEMS
Bin # • ,
City of ' La Quin to
Building 8i' Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
�sl'IJ a0a6649
Project Address:}—tqD J ra' ^ffl
Owner's Name: o 0 •
A. P. Number:
Address: Q
Legal Description:
City, ST, Zip:
Contractor•. :: s "
Tele hone.•
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Address:?c/O �/�
Project Description:
City, ST; ZipJ��
3�_T l:/ \ l T ) C �
4 Tele h one.
P -s3a-I
State Lic. # :
City Lie. #;
Arch., Engr., Designer:
Address:
City,, ST, Zip:,
Telephone:
one:
�o
ancY
Cnstruction Type: Occupancy:
State Lac .#
n Alter Repairair Demo tYPa (circle one): New
Add'
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
bmittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
A nt Y
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balan
Title 24 Calcs.
ns picked up
Construe '
Flood plain plan
Plans resu 'tted
Wch..ical
Grading plan
2"d Review, readctions/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitte
Grading
IN IiOUSE:-
'r°. Revi , ready for corrections/issue
D toper Impact Fee
Planning Approval
ailed Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issdc
School Fees,
Total Permit Fees