The URL can be used to link to this page

BCOM2016-006278-495 CALLE TAMPICO LA gUINTA, CALIFORNIA 92253 DESIIG�LN(& DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BCOM2016-0062 Property Address: 47110 WASHINGTON ST 103 APN: 643200035 Application Description: OLIPHANT / INTERIcgoRkm TIONS/ Property Zoning: f� - Application Valuation: $5,000.00 D Applicant: " AFFILIATED CONSTRUCTION CO QUWTA 77900 AVENUE OF THE STARS OF PALM DESERT, CA 92211' C)� ES1GN AND D�E��PMENT DEPARTMEN (760)345-2626 Llc. No.: 186863 ------------------------------------------------- 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:'B License No.: 186863 I'Contra r: __,71,�6 •OWNER-BUILDER�ECLA 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 C, 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-drahe did not build or improve for the purpose of sale.). 1, 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: 'VOICE (760) 777-7125 FAX (760) 77777011 INSPECTIONS (760)777-7153 Date: 1/3/2017 Owner: CALEO BAY INV 77900 AVE OF THE STATES PALM DESERT, CA 92253. Contractor: AFFILIATED CONSTRUCTION CO 77900 AVENUE OF THE STARS PALM DESERT, CA 92211 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' Co mpensation, as provided for by Section 3700 of th_e Labor Code, for.the performance of the tivork for which this permit is issued. 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9164716 S 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 l should become sub ct to the workers' compensation provisions of Section 3700 of the Labor Cod shall forthwith comply with those provisions. Dater . ( 3 t 7,.,- "Applica t WARNING: FAILURE TO SECURE WORKERS: C PENSATION 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.COSTOF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT '-1 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 omissidn 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 corp�ct. I agree to comply with all city and county ordinances and state laws relating to b +iding construction, and hereby authorize representatives of this city to enter upon t above-mentioned property for inspection purposes. l7 / Oate:Y /1' Signature,(ApplicanforAgent + FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $25.33 . DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $25.33 Total Paid for ELECTRICAL: $50.66 DESCRIPTION ACCOUNT QTY AMOUNT APPLIANCE REPAIR/ALTERATION 101-0000-42402 0 $12.67. DESCRIPTION - ACCOUNT. QTY AMOUNT APPLIANCE REPAIR/ALTERATION PC 101-0000-42600. 0 $5.07 - Total Paid for MECHANICAL: $17.74 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $25.34 DESCRIPTION. ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600. 0 $25.34 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP . 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.67 Total Paid for PLUMBING FEES: $76.02 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, EA ADDITIONAL 500 SF 101-0000-42400 0 $45.60 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, EA ADDITIONAL 500 SF PC 101-0000-42600 0 .$36.48 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, FIRST 100 SF 101-0000-42400 0 $51.68 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, FIRST 500 SF PC 101-0000-42600 0 $141.36 Total Paid for REMODEL: $275.12 DESCRIPTION ACCOUNT QTY AMOUNT SMI - COMMERCIAL 101-0000-20308 0 $1.40 Total Paid for STRONG MOTION INSTRUMENTATION SMI: $1.40 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00. . r Bin # CIA pity of La Q uin to Building &r Safety Division Permit # 78-495 Calle Tampico �jCi0nt1?ptb- d0� La Quinta, CA 92253- (760) 777-701,2 Building Permit Application and Tracking Sheet roject Address: 7 l t� W �1, •u 0 ?b N S Owner's Name: A. P. Number: S✓�TG— 13 Address: Legal Description: City, ST, Zip: Contractor: -� � fi r' S` Cc,o Telephone: 6 3 2 G Address:tion: ro ect Description: / J P �S J(1..7 .5 City, ST, Zip: Telephone: State Lic. # : 6 U 63; City Lic #.: Arch., Engr., Designer: Address: City, ST, Zip: h Telephone: one: Construction Type: Project type (circle one), New Acd'nAlter Repair Demo Sta toic- # L - • Name of Contact Person:V61—r-10(� �� S t.: #Stories: # Units: Telephone # of Contact Person: 7 3 5 Z(o Z Estimated Value of Project: 400 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submittedta Item • Amount Structural Caics. Reviewed, ready for corrections Plan Check Dei)osit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Calcs. Plans picked up Construction Floodplain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue _ Electrical . Subcontactor List Called ContactPerson Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN ROUSE:- '"! Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. \VI s- Appr Date orpermit issue School Fees, l Total Permit Fees -77 27Zot6 I" (!2(;- &PT- APPRo��