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BELC2017-001878-495 CALL•E TAMPICO LA QUINTA, CALIFORNIA 92253 'DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Application Number: BELC2017=0018 Owner: Property Address: 48111 VIA HERMOSA JULIUS WASHINGTON APN: 646100016, Property Zoning: issued. My workers' compensation insurarce carrier and policy number are: OWNER-BUILDERCLARATION Application Valuation: $500.00 1 certify that in the performanceof the work for which this permit is issued, I Applicant: Contractor: LOUIS R GUILBAULT LOUIS R GUILBAULT 53=501 AVENIDA DIAZ 53=501 AVENIDA DIAZ LA QUINTA, CA 92253-3582 LA QUINTA, CA 92253=3582 - : (760)899-70 1 LI N • 830b11 ' Date: _2/28/2017 z 1 hereby affirm under penalty of perjury ore of the following declarations: w � D as compensation, as provided for by Section __700 of the Labor Code, for Lhe performance z� o C1115i _ --- —` I have and will maintain worker_' compensation insurance, as required by W aa1 LU V— p� u-9 LU � I z 2 0 00 c. 0.. 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 ore of the following declarations: (commencing with Section 7000) of Division 3 of the Business and Professions Code, and _ I have and will maintain a certifEate of consent to self -insure for workers' my License is in full force and, effect. compensation, as provided for by Section __700 of the Labor Code, for Lhe performance License Class: C54 License No.: 830611 f the work for which this permit is issued- _ --- —` I have and will maintain worker_' compensation insurance, as required by ,':Date: , — i Contracto Section 3700 of the Labor Code, for the performance of the work for'which this permit is issued. My workers' compensation insurarce carrier and policy number are: OWNER-BUILDERCLARATION Carri CEMPT Policy Number. _ I hereby affirm under penalty of perjury that I am exempt from the Contractor's State 1 certify that in the performanceof the work 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 mannen 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 _ ar and Professions Code) or that he or she is exempt therefrom and the basis for the Date: 'Applicant - 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).: WARNING: FAILURE TO SECURE WORKERS' C PENSATION COVERAGE IS UNLAWFUL, (_J I, as owner of the property, or my employees with wages as their sole AND SHALL SUBJECT AN EMPLOYER.TO CRIAINAL PENALTIES AND CIVIL FINES UP TO compensation, will do the work, and the structure is not intended or offered for sale. ONE 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 OR 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. J himself or herself through his or herown 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 :his 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 to an owner of property who builds or improves thereon, as a result of this application , the owner, aad the applicant, each agrees to, and'shall and who contracts for the projects with a contractor(s) licensed pursuant to the defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and . Contractors' State License Lam): employees for any act 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 Date: Owner: for 180 days will subject permit to cancellation. , CONSTRUCTION LENDING AGENCY ' I certify that I have read this application anc state that the above information is correct. I hereby affirm under penalty of perjury that there is a construction lending agency for I agree to comply with all city and county. ordinances and state laws relating to building the performance of the work for which this permit.is issued (Sec. 3097, Civ. C.). i construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. Lender's Name: Dat Signature (Applicart of Agent) Lender's Address: Date: 2/28/2017 Application Number: BELC2017-0018 Owner: Property•Address: 48111 VIA HERMOSA 1ULIUS WASHINGTON APN: 646100016 Property Zoning, Application Valuation: $500.00 Applicant: Contractor: LOUIS R GUILBAULT LOUIS R GUILBAULT 53-501 AVENIDA DIAZ 53-501 AVENIDA DIAZ LA QUI NTA, CA 92253-3582 LA QUINTA, CA.92253-3582 .. " (760)899-701.1 Llc. No.:830611 Detail; FINANCIAL •• - 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 PERMIT -ISSUANCE .101-0000-42404 0 $96.27 Total Paid for PERMIT ISSUANCE: $96.27 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY: ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5 00 TOTALS: i Bin # ry Building a Safety Division �? " Permit #i `' 78-495 Calle Tampico o „� i 1•. La Quinta, CA 92253'-'(760) 777-701,2 �. �E LC; -a:0-1 7 - C'?0l8 : BuiilMg Permit Application and Tracking Sheet } Project Address, O!, - Owner's Na[ne� �1 (�[ �j Q .y A. P. Number: ;' Address: �. + Legal Description: t' City, ST, zip: Y?hoc 12 3 ra _ Cot ct r: o % t7 f /L c;c ho e: r Telephone: P , Address: , �•... �� ^0 -77 1 -da � t � z• ' � Project Description:�A / 6 (- �`� . . City' ST, Zip: / .'}'j. �' 9,20 -yo Tele. eh no - P r id A/1-0 All State Lic. #:. - City Lie. #. Arch.,`Engr., D?111Ak Address: - S City, ST, Zip:, Telhone: •• aneY: Co tructi n Type: Occupancy: State Lic. #. • e c r neNAddn Alter Repair.e o `Demoo tac Name of Cont Persor�% �� % �� ( (,(_ j A%�t'Gc k q. Ft.:-) # Stories. # Units: Telephone # of ContactPerson: O , ct I,� 6,t stimated Value of Proje ' , Q� �f r ® 'BELOW •THIS LINE, O % /• APPLICANT: DO NOT WRITE # Submittal Req'd Rcc'd TRACKrNG PERMIT FEES Plan Sets Plan Check submitted Item Amount'• 7 Structural Calcs. Reviewed, ready for corrections {. Plan Check Deposit ` Truss Cales._ , 'Called Contact Person ' �r Plan Check Balance, Title 24 Calcs. Plans picked up. Construction 1: " Flood plain plan Pians resubmitted Mechanical ^ Grading plan- " 2" Review, ready fodcorrectionshssue Electrical , Subcontactor List - Called Contact Person Plumbing Gran( Deed 1 Plans picked upF H.O.A. Approval ;: Plans resubmitted ', Grading IN HOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person .Pub. \Vks. Appr Dale of permit issue i School Fees, ' r � Total Permit Fees i S - luj