Loading...
BELC2016-0078I 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.: 3005249 .���/ Dat [ ! 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 ) 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 ) 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 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' co Wion3700 tion, as provided for by Section 3700 of the Labor Code, for the performance r which this permit is issued. ave and will maintain workers' compensation insurance, as required by Seof 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: EXEMPT Polity 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 sybjectIpAtre workers' compensation provisions of Section 3700 of the Labor I f with comply with those provisions. /I Dater 4n App' nt: WARNING: FAILURE TO SECUR S' 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, DAMAGESAS 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 in construction, and hereby authorize representatives of this city to enter upo e above-mentioned property for inspection purposes. -01 Date: �/ &Signature (Applicant or Age VOICE 78-495 CALLE TAMPICO ' C� D �1 (760) 777_7125 LA QUINTA, CALIFORNIA 92253 FAX (760 ) FAX777-7011 DESIGN &DEVELOPMENT DEPARTMENT (760) 777-7153 BUILDING PERMIT Date: 9/15/2016 Application Number: BELC2016-0078 Owner: Property Address: APN: 53364 VIA PALACIO 777220023 JACOB TAUBER ------ 12007 CREST CT Lr Application Description: TAUBER / ELECTRICAL REVISION TO BRES2016-0051 BEVERLY HILLS, CA 92253 Property Zoning: Application Valuation: $8,000.00 v 3 LIJ Applicant: Contractor: oBRADLEY CONSTRUCTIONBRADLEY CONSTRUCTIOL.4443803 Li ANATRA PLACE 43803 ANATRA PLACE INDIO, CA 92203 INDIO, CA 92203(760)899-0122 Llc. No.: 1005249 I 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.: 3005249 .���/ Dat [ ! 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 ) 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 ) 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 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' co Wion3700 tion, as provided for by Section 3700 of the Labor Code, for the performance r which this permit is issued. ave and will maintain workers' compensation insurance, as required by Seof 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: EXEMPT Polity 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 sybjectIpAtre workers' compensation provisions of Section 3700 of the Labor I f with comply with those provisions. /I Dater 4n App' nt: WARNING: FAILURE TO SECUR S' 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, DAMAGESAS 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 in construction, and hereby authorize representatives of this city to enter upo e above-mentioned property for inspection purposes. -01 Date: �/ &Signature (Applicant or Age Date: 9/15/2016° i Application Number: BELC2016-0078 Owner; Property Address: 53364 VIA PALACIO - JACOB TAUBER APN- , 777220023 12007 CREST CT Application Description: TAUBER / ELECTRICAL REVISION TO BRES2016-0051 BEVERLY -HILLS, CA 92253 Property Zoning: Application Valuation: $8,000.00 Applicant: Contractor: BRADLEY CONSTRUCTION BRADLEY CONSTRUCTION 43803 ANATRA PLACE 43803 ANATRA PLACE INDIO, CA 92203 INDIO, CA 92203 ,..; (760)899-0122 . Lit. No.: 1005249 Detail: INSTALL 1" PVC WITH 3 #6 THHN AN 1#8 THHN FROM EXISTING 400 AMP SERVICE TO NEW 50 AMP SUB PANEL AT EXISTING ISLAND. THIS SUB PANEL AND NEW WIRING IS FOR FUTURE USE OF TRELLIS` HEATERS, MISTING SYSTEM AND TRELLIS WILL BE PER SEPERATE PERMITS. ALL WORK SHALL BE PER 2013 CEC CODES r 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 Credit Card Fee 101-0000-43505 0 $3.11 ' Total Paid for Credit Card Fee: $3.11 DESCRIPTION ACCOUNT QTY AMOUNT OTHER ELECTRICAL EQUIPMENT- 101-0000-42403 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT OTHER ELECTRICAL'EQUIPMENT PC 101-0000-42600 '. 0 $24.17, ` Total Paid for ELECTRICAL: $48.34 DESCRIPTION. ACCOUNT CITY AMOUNT PERMIT ISSUANCE 101-0000-42404 0 $91.85