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BSPN2015-0060OR 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Applicant: LEAH ABRIEL 78060 CALLE ESTADO LA QUINTA, CA 92253 `^F1'w4�rw COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BSPN2015-0060 78115 CALLE ESTADO 206 770152017 MILLER/ SPECIAL INSPECTION FOR IID RELEASE 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 ($500).: ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the -structure isnot 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.). (1 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 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: 75 VOICE (760).777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/17/2015 Owner: MFH PIERCE GROUP 838 SW IST AVE STE 210 0 c PORTLAND, OR 92253 c F-� o "-' ^m rn J T (jj O ►r Contractor: n m � O a � m G Cti 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. 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 Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE 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 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 enter upon the above-mentioned property for inspection purposes. i Date ! J Signature (Applicant or Agent)1 `Ir DESCRIPTION FINANCIAL a . ACCOUNT: ; CITY`AMOUNT'. ,, , PAID PAID DATE SPECIAL INSPECTION 101-0000-42404 0 $72.52 $0.00 PAID BY METHOD RECEIPT # ..., : P CHECK # CLTD BY,; Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $72.52 $0.00 TOTALS:00 Description: MILLER/ SPECIAL INSPECTION FOR IID RELEASE Type: SPECIAL INSPECTION Subtype: Status: UNDER REVIEW Applied: 12/17/2015 SKH Approved: Parcel No: 770152017 Site Address: 78115 CALLE ESTADO 206 LA QUINTA,CA 92253 Subdivision: Block: Lot: Issued: Lot Sq 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 OR 92253 (760)698-9613 Details: SPEICAL INSPECTION FOR IID RELEASE. THIS PERMIT IS NOT FOR WORK. 2013 CALIFORNIA BUILDING CODES. FINANCIAL INFORMATION CONUMONS DESCRIPTION T ACCOUNT QTY AMOUNT PAID CONTACTS SPECIAL INSPECTION 101-0000-42404 0 $72.52 NAME TYPE NAME ADDRESSI CITY ' STATE ZIP PHONE FAX EMAIL .. APPLICANT LEAH ABRIEL 78060 CALLE ESTADO LA QUINTA CA 92253 (760)698-9613 OWNER MFH PIERCE GROUP 838 SW IST AVE STE 210 PORTLAND OR 92253 (760)698-9613 FINANCIAL INFORMATION DESCRIPTION T ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY' CL BY SPECIAL INSPECTION 101-0000-42404 0 $72.52 $0.00 Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $72.52 $0.00 TOTALS:0i Printed: Thursday, December 17, 2015 10:34:29 AM 1 of 2 SYSTEMS PARENT PROJECTS BOND INFORMATION F, MFH- Pierce Group, LLC Property Manager 78o6o Calle Estado Office: 76o.698.9613 La Quinta, CA 92253 Fax: 76o.564.0369 Leah@mflillc.com Printed: Thursday, December 17, 2015 10:34:29 AM 2 of 2 VF SYSTEiv15 Bin # City of La Quinta Building &r Safety Division . . 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: -797/5 Ca//e C-3t74db (?2-ze Owner's Name: A. P. Number: 99 . S14IM20to . Address: J8DW 6all(fe!S�610 Legal Description: Q iiT,J Qff—k4�� * ) City, ST, Zip:ZA 0 W,;v� ) CA- q2 -7's 3 Contractor: Telephone: Address: Project Description: Al&d lezechx, la City, ST, Zip: Telephone: r ov&—o qeAr- State Lic. # City 'Lie. #: L/ Arch., Engr., Designer: Address: City., ST, Zip: Telephone: ................... 1. ... ........ . ..... ...... .......... .. ....... .......... ....... . .... ........... Conuction T'Ype: Occupan*cy: str State Lic. Project type (circle one): New Add'n Alter Repair Demo .... Name of Contact Person: Sq. Ft.: ? # Stories: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT. WRITE BELOW THIS LINE N 'Submittal Reqld Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural CaIcs. 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'd Review, ready for correctionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. I-I.O.A. Approval Plans resubmitted Grading IN ROUSE:- Re.view, 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, Total Permit Fees J