BSPN2017-000278-495 CALLE.TAMPICO O� a VOICE (760) 777-7125
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LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
:BUILDING PERMIT
.Date: 1/4/2017
Application Number: BSPN2017-0002 Owner:
Property Address: 50855 WASHINGTON ST 2B, %� LQ INV
APN: 770020017 [rz� 17165 NEWHOPE ST
Application Description: LIZ CARTER DESIGNS / UTILITY REL FOUNTAIN.VALLEY, CA 922S3
Property Zoning: JAN 0.4 Z017
Application Valuation: .
CITY OF LA QUINTA : .
Applicant: COMMUNITYDEVELOPMENTDEPARTMENT Contractor:
LIZ CARTER
50855 WASHINGTON ST STE 132 >
LA QUINTA, CA 92253 -
Llc. No.:
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm urider penalty of perjury that I am licensed under provisions of Chapter I hereby affirm under penalty of perjury one of the following declarations:
9 {commencing with Section 70001 of Division 3 of the Business and Professions Code, I have and will maintain.a certificate of consent to self-insure for workers'
and my License is in full force and effect. compensation, as provided for by Section 3700 of the Labor Code, for the performance
License Class: _ License No.: _ of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Date: Contractors 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 DECLARATION • Carrier: - Policy Number:
t I hereby affirm under penalty of perjury that I am exempt from the Contractor's State I certify that in the performance of thework for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any shall 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 compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a workers' compensation provisions of Section 3700 o Labor C shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the comply with th "se provisions.
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,
° Date: -d � - Appj'cant..
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 WARNING: FAILUR TO SECURE S' COMP N ION COVERAGE IS UNLAWFUL,
($500).: AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(_) I, as owner of the property, or my employees with wages as their sole ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended'or offered for sale. COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR. CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not INTEREST, AND ATTORNEY'S FEES.
apply to an owner of property who builds or improves thereon, and who does the work t
himself or herself through his or her own employees, provided that the improvements APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner-builder will have the burden of proving that the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.). 1. Each person upon whose behalf this application is made, each person at whose
(_) I, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or
the Contractors' State License Law.). following issuance of this permit.
(_) I am exempt under Sec. B.&P.C. for this reason 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.
Date: Q
I certify.that I have read this application and state that the above information is correct.
CONSTR ION LENDING AGENCY I agree to comply with all city and county ordinances and state laws relating to building
(hereby affirm under penalty of perjury that there is a construction lending agency for construction, and hereby authorize representatives of this city t nter upo he
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). above-mentio ed p. operty for inspection purposes..
Lender's Name: t Date:Signature (Applicant or Age
Lender's Address:
Date: .1/4/2017
:Application Number:
BSPN2017'0002
Owner.. ..
Property' Address:
50855 WASHINGTON ST 28
LQ INV
APN: -
770020017
17165 NEWHOPE ST
Application Description:
LIZ CARTER DESIGNS / UTILITY RELEASE
FOUNTAIN VALLEY, CA 92253
Property Zoning:,
Application Valuation:
Applicant:
Contractor,.
LIZ CARTER
.50855 WASHINGTON ST
STE B2
t
LA QUINTA, CA 92253
Llc. No.:
Detail:
j
'�;','fINANCIAL
DESCRIPTION
INFORMATION
ACCOUNT CITY
AMOUNT
SPECIAL INSPECTION ..
101-0000-42404 0
$76.00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$76:00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Din #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Addres6-6„ "55, W aS >
Owner's Name: Z z '
A. P. Number:
Address:
Legal Description:
City, ST, Zip: /
L fi►'1 A
C
Contractor:
Tele hone: 9/ Z
Address:
Project Description:
City, ST, Zip:
L
Telephone:
.'•;��3;}i:4i '..Yr' �f::::S:v::sr,;•f,.:i:f•3;;
State Lic. # :
City Lic. #;-
'Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
, z
� �� y ,
Y :>' ; :<:: <: .
Construction Type: Occupancy:
State Lic. #:
Project type circle one New Add'n Alter Repair Demo
Name of Contact Person:
Sq. E"-: O 0
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
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 Cates.
Clans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2p° Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
1
H.O.A. Approval
Plans—resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees