13-1450 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 13-00001450
Property Address: 53125 AVENIDA HERRERA
APN: 774-053-018-6 -000000-
Application description: SPECIAL INSPECTION
Property Zoning: COVE RESIDENTIAL
Application valuation: 0
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BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
-----------------
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 Professionals 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
pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
1 1, 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 ISec. 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
111AAAtt` .improve for the purpose of sale J.
1 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.l.
1- 1 I am exempt under Sec. B.&P.C. for this reasprf /
,
Date
f
r
I hereby affirm/under penalty of
work for which this permit is is:
Lender's Name:
I
Lender's Address:
LQPERMIT
Owner:
%'CONSTRUCTION LENDING AGENCY
at there is a construction lending agency for the performance of the
3097, Civ. C.).
Owner:
SRP SUB LLC.'
5440 TRABUCO ROAD #H2O0
IRVINE, CA 92620
(949)629-5795
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/14/13
Contractor:
Owner D a
NOV 14 2813 ,
CITY OFLA Q TSN Au
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 -4 --------------- - - - - - -Policy Number
J certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner so o become ject to the workers' compensation laws of California,
and agree that, if I sho ecome s ) to the workers' compensation provisions of Section
3 00 of the Labor C d I shall rt ith comply with those provisions.
Date: �I I APPlicantZ111 1-1
:'
WARNING: FAILURE TO SE E 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 Director of Building and Safety 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. Arty 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 o ork for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that the ab o i ormat' is c act. I agree to comply with all
city and county ordinances and state laws relating to buildi gco truc ' n, a ereb .authorize representatives
of this cou y to ter upon the above-mentioned prope fo nsp ion pose
'Date:/ Signature (Applicant or Agent):
Application Number . . . . . 13-00001450
Permit . . . SPECIAL INSPECTION
Additional desc .
Permit Fee . . . . 71.50 Plan Check Fee .00
Issue Date . . . . Valuation . . 0
Expiration Date 5/13/14
Qty Unit Charge Per Extension
1.00 71.5000 EA MISC SPECIAL INSPECTION 71.50
---------------------------------7------------------------------------------
Special Notes and Comments
SPECIAL INSPECTION - ELECTRICAL TO
RELEASE METER.
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 71.50 .00 .00 71.50
Plan Check Total .00 .00 .00 .00
Grand Total 71.50 .00 .00 71.50
LQPERMIT
Bin # City of La. QUfhtd
Building &r SafetyDivision
Permit # P.O. Box 1504, 78-495 Calle Tampico
1
141
Submittal
Req'd
Ld wU111I.d,4—^7LLJJ-t/OVJ///-/V1L
Building Permit Application and Tracking Sheet
Project Address: S
PERMIT FEES
Owner's Name: G f?—f 5 V b L c,
A. P. Number: — 3 —
— '7
45 j yqv -7
Legal Description:
City, ST, Zip: (/%JL (-e ' q
Contractor:
Tele hone: / Z �-7 9�
Address:
Project Description: PC4
City, ST, Zip:
Plan Check Deposit
Telephone:
Truss Calcs.
State Lic. # :
City Lic. #;
Arch., Engr., Designer.
Address:
City., ST,. Zip:
Construction
Telephone:
::;::::;..::a:.;:::•':<''>::::«;;».<;.r::: >:::
'`^ 'rs.; `""'"`"' "'"`'""'s' '
Construction Type: Occupancy:
State Lic. #
Project type circle one): New Add'n Alter Repair Demo
Name of Contact Person:)VL PO\f
P9
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person:
D
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rcc'd
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 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"` Review, ready for correctionstssue
Developer Impact Fee
Planning Approval
Called Contact Person,
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
Schodl Fees
Total Permit Fees
CALIFORNIA ALL-PU®SE
CERTIFICATE OF ACKNOWLEDGMENT
State of California
County of P ?
(
On �0U.12 Th 20before me, �g4eanne-
J(
(Hue insert name and title of tha off
personally appeared 1Davicl r,,a- L4—
Rt bl )"&
who proved to me on the basis of satisfactory evidence to be the person hose name is/subscribed to
the within instrument and acknowledged to me that he/ �executed the same in his/} dxOrauthorized
capacityaies�, and that by his/l�ar> signature�on the instrument the personWo�r the entity upon behalf of
which the person; acted, executed the instrument.
I certify under PENALTY OF PERiURY under the laws of the State of California that the foregoing paragraph
is true and correct. blow
BREANNE SAR L
r COMMISSION #1972349
WITNE S my hand and offic' Seal. Notary Publ(c - California
ORANGE COUNTY tj
My Commission Explres
MARCH 17, 2016
sigria1useofNotaryPubl
ADDITIONAL OI'TIONA.L INFORMATION
DESCRIPTION OF THE ATTACHED DOCUMENT
6AAhO 21! L be— fv)?— SRPSubU
(Title or description ofattaehed document)
(Title or descriPlion of attached document coni ued)
Number of Pages Document Date )QV, � �t20le
Iota
(Ad itional information)
CAPACITY CLAIMED BY THE SIGNER
❑
Individual (s)
❑
Corporate Officer
(Title) -- '
❑
Partner(s)
❑
Attorney -in -Fact
❑
Dustee(s)
❑
Other
2008 Version CAPA v12.10.07 800.873-9865 www.NotaryClasses.com
INSTRUCTIONS FOR COMPLETING THIS FORM
Any acknowledgment completed in Cal/fornta must contaln verbiage exactly as
appears above in the notary section or a separate acknowledgment john must be
properly completed and atrnched to that document The only exception is Ira
document is to be recorded outside of California. /n such instances, any alternative
oJinowledgmeni verbiage as may be printed on such a document so long as the
verbiage does not require the notary to do something that is Illegal for a notary to
California (i.e certifying the authorized capacity of tha signer)• PIMP. deck the
document rarefullyfor proper notarial wording and attach this form Ifregtdred.
• State and County information must be the State and County where the document
signer(s) personally appaased before the notary public for acknowledgment.
•
Date of notarization must be the date that the signer(s) personally appeared which
must also be the same date the acknowledgment is completed.
• The'notary public must print his or her name as it appears within his or her
commission followed by a comma and then your title (notary public).
• Print the names) of document signer(s) who personally appear at the time of
notarizalion.
• Indicate the correct singular or plural forms by crossing off incorrect forms (.e.
he/shdthe.. is /arc ) or circling the correct forms. Failure to correetly indicate this
information may lead to rejection of document recording.
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impression must not cover text or lines. If seal impression smudges, rc-seal if a
sufficient area permits, othirwise aompiele a dillareot acknuwledgmeni form.
• Signature of the notary public must match the signature on file with the office of
the county clerk.
Additional information is not required but could help to ensure this
acknowledgment is not misused or attached to a different document.
Indicate title or type ofanached document, number ofpages and date.
indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer, indicate the title (i.e. CEO, CFO, Secretary).
Securely attach this document to the signed document
W A Y P I N T;
Waypoint Homes
5400 Trabuco Road Suite H-200
Irvine, CA 92620
November 13, 2013
To Whom It May Concern:
I hereby authorize Brian Gray to apply for, execute, receive and perform all
acts necessary to obtain planning approvals, building permits, business and other licenses as well
as attend hearings for any home that is currently owned by Waypoint Homes under the holding
entity of SRP Sub LLC.
This authorization shall remain in effect for the period of 12 months from the date of this letter.
,Please feel free to contact me with any questions regarding this matter.
Sincerely,
t%cN+I� kic��C
David Kakuk
Senior Construction Manager
714-231-7941
davidk@waypointhomes.com