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BPLB2015-011978-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: TESERRA P 0 BOX 1280 COACHELLA, CA 92236 c&t1t 4 4 Qu&rcv COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BPLB2015-0119 80736 CASTILLO DEL AREANA 762490020 FORD / INSTALL GAS LINES (1)FOR FIRE PIT (1)STUB FOR FUTURE 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: _ License No.: 656128 / D e: Contrac or. �srr6 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, 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, 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 Na Lender's Address: 29 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 10/22/2015 Owner: AV CONST 71905 HIGHWAY 111 STE G RANCHO MIRAGE,0\ J `CA Contractor: TESERRA P O BOX 1280 +� COACHELLA, CA 92236, (760)389-9222�� Llc. No.: 656128 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 o forf which this permit is issued. 2ave 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: _ Policy 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 subject to the workers' compensation provisions of Section 3700 of the abor Code, I shall forthwith comply with those provisions. _ Datgr,/W Zl ` (r Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 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 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 building construction, and hereby authorize representatives of this city to a upon the above-mentioned property for inspection purposes. Date: 5 L 4 Signature (Applicant or Agent): 01 FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY' AMOUNT PAID PAID DATE PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PERMIT ISSUANCE: $91.85 $0.00 DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $24.18 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $24.18 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for PLUMBING FEES: TOTALS:00 $48.36. $0.00 Description: FORD / INSTALL GAS LINES (1)FOR FIRE PIT (1)STUB FOR FUTURE Type: PLUMBING Subtype: Status: UNDER REVIEW Applied: 10/22/2015 SKH Approved: Parcel No: 762490020 Site Address: 80736 CASTILLO DEL AREANA LA QUINTA,CA 92253 Subdivision: TR 34243 Block: Lot: 20 Issued: - Lot Scl Ft: 0 Building Sq Ft: 0 Zoning:. Finaled: Valuation: $0.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: INSTALL GAS LINES (1)FOR FIRE PIT (1)STUB FOR FUTURE USE. 2013 CALIFORNIA BUILDING CODES. Printed: Thursday, October 22, 2015 11:59:38 AM 1 of 2 CRWIYSTEMS »w' DESCRIPTION ACCOUNT QTY { AMOUNT PAID PAID DATE' !RECEIPT#, CHECK #;. ,METHOD-` PAID BY. -s CLTD' BY WATER SYSTEM 101-0000-42401 0 $24.18 $0.00 INST/ALT/REP WATER SYSTEM 101-0000-42600 0 $24.18 $0.00 INST/ALT/REP PC Total Paid for PLUMBING FEES: $48.36 $0.00 BOND INFORMATION ATTACHMENTS Printed: Thursday, October 22, 2015 11:59:38 AM 2 of 2 Cp?SYSTEMS Qi a Jr City of La Quinta Building a Safety Division Permit P.Q., Box I SO4, 78-495 Calle Tampico _t La Quinta, CA 02253 - (760) 777-7012 Building Permit Application and TracUng Sheet Project Address: ,4 =4T n Did 4ret4f, I Owner's Name: A. P. Number: Address: 111,61 M-4 Legal Description: City, ST, Zip: Contractor:72-�— Telephone: N-1Jam Address: At)L Co :�7JR '51- Project Description: 4-C I*rl 14 City, ST, Zip: ll C,4ZZ-3 6, Telephone: Z 7-. Z_ State Lie. # City Lie. #: Arch., Engr., Designer: P& Address: City, ST, Zip: Telephone:' Constru.ction Type: Occupancy: State, Lie. Project type (cirele.one): 'NeV Add'n Alter Repair Demo Name of Contact Person: Sq. Ft_' # Stories: # Uriits: Telephone #of Contact Person:. 760 ),2_1 -71JI5- Estimated Value of Project: Cid -D APPLICANT: DO NOT WRITE BELOW THIS LINE N Submittal Req'd Reeld TRACING . PERAW FEES Flail Sets Plan Check submitted Item Amount Structural Coles. Reviewed, ready for corrections Flail Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy CaIcs. Plans picked up Construction Flood plain plan Plans resubmitted. Mechanical Grading plan 2 Review, ready for corrections/issue Electrical Subcontactor List Called Contact Verson Plumbing Grant Deed' Plans picked up S.M.I. H -0A. Approval Plans resubmitted IN HOUSE:- 3rd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees 1[ otal Permit Fees