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BRES2014-1055uucic/ ��4 a --------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 1 hereby affirm under penalty of perjury one of the following declarations: (commencing with Section 7000) of Division 3 of the Business and Professions Code, and _ I have and will maintain a certificate of consent to self -insure for workers' my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance of License Class: B License No.: 728302 the work for which this permit is issued. �� _ I have and will maintain workers' compensation insurance, as required by Da`"te Cant' rac"tor: 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: OWNER -BUILDER DEC TION Carriers/ Policy Number:_ I hereby affirm under penalty of perjury that I am exempt from the Contractor's State F I certify that in the performance of the work for which this permit is issued, I License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any sh I not employ any person in any manner so as to become subject to the workers' city or county that requires a permit to construct, alter, improve, demolish, or repair any compensation laws of California, and agree that, if I should become subject to the structure, prior to its issuance, also requires the applicant for the permit to file a signed workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith statement that he or she is licensed pursuant to the provisions of the Contractor's State comply with those provisions. 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 Date: Applicant:! 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).: WARNI G: FAI URE TO SECURE WORKERS' COMP SATION COVERAGE IS UNLAWFUL,. (_) I, as owner of the property, or my employees with wages as their sole AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE compensation, will do the wor'<, and the structure is not intended or offered for sale. HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, apply to an owner of property who builds or improves thereon, and who does the work INTEREST, AND ATTORNEY'S FEES. 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 APPLICANT ACKNOWLEDGEMENT within one year of completion: the owner -builder will have the burden of proving that he IMPORTANT: Application is hereby made to the Building Official for a permit subject to or she did not build or improve for the purpose of sale.). the conditions and restrictions set forth on this application. (� I, as owner of the property, am exclusively contracting with licensed contractors to 1. Each person upon whose behalf this application is made, each person at whose construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State request and for whose benefit work is performed under or pursuant to any permit issued License Law does not apply town owner of property who builds or improves thereon, and as a result of this application , the owner, and the applicant, each agrees to, and shall who contracts for the projects. with a contractor(s) licensed pursuant to the Contractors' defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and State License Law.). employees for any a --t or omission related to the work being performed under or (_) I am exempt under Sec. . B.&P.C. for this reason 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. VOICE (760) 777-7125 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 7/28/2014 Application Number: BRES2014 1055 Owner: Property Address: 54615 SEA HERO CIR IOTA GRIFFIN APN: 767780029 4675 MACARTHUR CT NO 1550 Application Description: GRIFFIN RANCH TRACT 32879 NEWPORT BEACH, CA 0 Propert 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:_ ! 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 :/ Signat rue (Applicant or Agent y Zoning: Application Valuation: $261,990.60 Applicant: Contractor: ULRICH SAUERBREY LENNAR HOMES OF CALIFORNIA INC USIandLink 25 ENTERPRISE 74948 LIVE OAK STREET ALISO VIEJO, CA 92656 INDIAN WELLS, CA 92210 (949)349-8000 Llc. No.: 728102 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:_ ! 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 :/ Signat rue (Applicant or Agent DESCRIPTION FINANCIAL ACCOUNT QTY :AMOUNT PAID PAID DATE ART IN PUBLIC PLACES - RESIDENTIAL 270-0000-43201 0 $154.97 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forART IN PUBLIC PLACES - AIPP: $154.97 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $11.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forBUILDING STANDARDS ADMINISTRATION BSA: $11.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - CIVIC CENTER 252-0000-43200 0 $942.00 $0.00 PAID BY METHOD RECEIPT# CHECK# CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - COMMUNITY CENTERS 254-0000-43200 0 $129.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - FIRE PROTECTION 257-0000-43200 0 $433.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - LIBRARIES 253-0000-43200 0 $344.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - PARK MAINTENANCE 256-0000-43200 0 $40.00 $0.00 PAID.BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - PARKS/REC 251-0000-43200 0 $2,048.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - STREET MAINTENANCE 255-0000-43200 0 $116.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DIF - TRANSPORTATION 250-0000-43200 0 $2,842.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for DIF - SINGLE FAMILY DWELLING: $6,894.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,000SF 101-0000-42403 0 $60.80 $0.00 PAID BY, METHOD RECEIPT# CHECK# CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, EA ADDITION 1,060SF, PC 101-0000-42600 0 $25.05 $0.00 PAID BY :METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF 101-0000-42403 0 $143.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ;.ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL, FIRST 1,000SF, PC 101-0000-42600 0 $47.19 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY i Total Paid for ELECTRICAL - NEW CONSTRUCTION: $276.04 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RESIDENTIAL FINISH GRADING PC 101-0000-42600 0 $143.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY ' Total Paid forGRADING: $143.00 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR 101-0000-42402 0 $107.25 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $71.49 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD 101-0000-42402 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY i DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE EXHAUST HOOD PC 101-0000-42600 0 $4.77 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FURNACE 101-0000-42402 0 $107.25 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE FURNACE PC 101-0000-42600 0 $71.49 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE VENT FAN 101-0000-42402 0 $83.44 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE VENT FAN PC 101-0000-42600 0 $33.39 $0.00 PAID BY t METHOD RECEIPT # CHECK # CLTD BY Total Paid for MECHANICAL: $491.00 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE MULTI -SPECIES RESIDENTIAL 0-8 UNITS 101-0000-20310 0 $1,292.00 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid forMULTI-SPECIES RESIDENTIAL• $1,292.00 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE NEW CONSTRUCTION PERMIT 101-0000-42400 0 $608.15 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for NEW CONSTRUCTION PERMIT: $608.15 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,294.24 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY 4 Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,294.24 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BACKFLOW DEVICE 101-0000-42401 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE BACKFLOW DEVICE PC 101-0000-42600 0 $4.77 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE BUILDING SEWER 101-0000-42401 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE BUILDING SEWER PC 101-0000-42600 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP 101-0000-42401 0 $274.16 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $274.16 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $35.75 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE GAS SYSTEM, S+OUTLETS PC 101-0000-42600 0 $23.83 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT 101-0000-42401 0 $23.84 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER HEATER/VENT PC 101-0000-42600 0 $14.30 $0.00 PAID.BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $11.92 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PLUMBING FEES: $710.41 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SMI - RESIDENTIAL 101-0000-20308 0 $34.06 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY V 0 . Total Paid forSTRONG MOTION INSTRUMENTATION SMI: $34.06 $0.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE SINGLE FAMILY DETACHED 224-0000-20320 0 $1,837.44 $0.00 PAID BY METHOD " -. RECEIPT # CHECK # CLTD BY Total Paid forTUMF - RESIDENTIAL:$1,837.44 $0.00 TOTALS: 00 0 Permit Number: BRES2O14-1055 Description: GRIFFIN RANCH TRACT 32879 Applied: 7/15/2014 Approved: Site Address: 54615 SEA HERO CIR Issued: Finaled: City, State Zip Code: LA QUINTA, CA 92253 Status: SUBMITTED Applicant: ULRICH SAUERBREY Parent Permit: Owner: IOTA GRIFFIN Parent Project: Contractor: LENNAR HOMES OF CALIFORNIA INC Details: 4,036SF DWELLING - PLAN 1XC, SERIES II, LOT 252 [VB/RES-3/CLASS-A/13D] THIS PERMIT DOES NOT INCLUDE POOL, SPA, BLOCK WALLS, BBQ OR WATER FEATURE. 2013 CALIFORNIA BUILDING CODES. Printed: Monday, 28 July, 2014 1 of 1 srsre ms