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BDEM2016-000378-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: MARK CHILD c&'Y, 4 4 Qubd�� COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BDEM2016-0003 49275 AVENIDA EL NIDO 658290010 INTERIOR DEMOLITION ONLY OF SINGLE FAMILY DWELLING 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.: 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1--ao).: I, as owner of the property, or my employees with wages as their sole c mpensation, 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 wi i one year of completion, the owner -builder will have the burden of proving that he korJshe did not build or improve for the purpose of sale.). s owner of the property, am exclusively contracting with licensed contractors o 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 th on, and who contracts for the projects with a contractor(s) licensed pursuant to e ontractors' State License Law.). I am exempt under Sec. B.&P.C. his reason Date:4:2 s 1� O CONSTRU ION 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: / 7 Lender's Address: 6, VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 1/28/2016 Owner: ST THOMAS MISSION GROUP INC 1251 MONTALVO WAY NO F PALM SPRINGS, CA 92253 co tl Contractor: OWNER BUILDER © N a cJD g Qa Llc. No.: 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. workers' compensation insurance carrier and policy number are: Ca �er: Policy Number: ertify 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 Labor Code, I shall forthwith comply wit those pr visions. (\ Date: ApplicaiT . WARNING: FAILURE TO SECURE WORKRS' 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 constructioffignature uthorize represen'oses. s of this city er upon the above-menfor inspection pu Date: (Applica Permit Details PERMIT NUMBER I t City of La Quinta BDEM2016-:0 Description: INTERIOR DEMOLITION ONLY OF SINGLE FAMILY DWELLING Type: DEMOLITION Subtype: SINGLE FAMILY Status: UNDER REVIEW Applied: 1/27/2016 BHA Approved: Parcel No: 658290010 Site Address: 49275 AVENIDA EL NIDO LA QUINTA,CA 92253 Subdivision: LA QUINTA GOLF ESTATES 1 Block: 'Lot: 119 Issued: Lot Sq Ft: 0 Building Scl Ft: 0 Zoning: Finaled: Valuation: $0.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 NAME TYPE Details:. INTERIOR DEMOLITION OF ITEMIZED AREAS OF 3971 SF DWELLING PER DEMOLITION PLAN. THIS PERMIT ASSOCIATED WITH BRES2016-0006. 2013 CODES. ADDITIONAL SITES ILHKONOLOGY CONDITIONS CONTACTS DESCRIPTION ACCOUNT' QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY NAME TYPE . NAME ADDRE5S1 CITY STATE ZIP PHONE FAX EMAIL APPLICANT MARK CHILD CONTRACTOR OWNER BUILDER OWNER ST THOMAS MISSION GROUP INC 1251 MONTALVO WAY NOF PALM SPRINGS CA 92253 FINANCIAL•• • CLTD DESCRIPTION ACCOUNT' QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY BY DEMOLITION, INTERIOR 101-0000-42404 0 $36.26 $36.26 1/28/16 R12401 1030 CHECK 49275 AVENIDA EL SKH NIDO Printed: Thursday, January 28, 2016 9:34:38 AM 1 of 2' MANAF CRUff SYSTEMS DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CL BY DEMOLITION, INTERIOR 101-0000-42600 0 $97.17 $97.17 1/28/16 R12401 1030 CHECK 49275 AVENIDA EL SKH PC NIDO Total Paid for DEMOLITION: $133.43 $133.43 PARENT PROJECTS Printed: Thursday, January 28, 2016 9:34:38 AM 2 of 2 CR? SYSTEti1S