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BELC2016-001478-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: Titw4 4Qumro COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT BELC2016-0014 80316 HERMITAGE 762200025 ELECTRRICAL CAR OUTTLET / BAKER $665.00 Applicant: VINTAGE E & S INC 49950 JEFFERSON STREET 130-388 INDIO, CA 92201 A 0 EB 2 2 201150 CITYOFLAQUINTA COMM KITYDE2,09P EW, DEPARTi(1ENT 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: C10, C46 License No.: 4`81352 / Date: �^ Z� ^ I V Contractor: t/ , t"', 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 ) 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 ) 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 Lender's Owner: DEE BAKER 330 N ORCHARD DR BURBANK, CA 92253 11 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 2/22/2016 Contractor: VINTAGE E & 5 INC 49950 JEFFERSON STREET 130-388 INDIO, CA 92201 (760)775-0135. Llc. No.: 481352 WORKER'S COMPENSATION DECLARATION I hey 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 thp�work for which this permit is issued. C7' 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.,,14y workers' compens tion insurance carrier and policy number are: Carrie{: Polity Number: 1 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. Date:-�� (� Signature (Applicant or Agent): 5 R, 'n51QM-.-, WINt.g",z, !gg " EStHIAMOUNTgiim PAID DATE I BSAS SB1473 FEE 101-0000-20306 0. $1.00 $0.00 11 TV, ma - byw� INRA.`�;,Hl IMEIT TD, XL 69 A 1: Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.,.00- $6.00. " DESCRIPTION V, -04m p AMOUNT;y PAID PAID DATE. RAN W x APPLIANCES, RE'S 101-0000-42403 0 $12.09 $0.00 V� g QzYMST' �,,.# CHECK #k- yg$lt"A' yllg,; ,.RECEIPT TOR". S# DESCRIPTION, IOUNTI IDM R.Rm �A igmA APPLIANCES, RES PC 101-0000-42600 0 $12.09 $0.60 r PAID BY vA ',v@jMiVW;T Dfl`M2 - -A 'HO 1g, P ;RECEIPT #�"CHECK C , R M� W 04 ip ;X� &WD Total Paid for ELECTRICAL: $24.18 $0.00 DESCRIPTION MS." Tf i:,N' 4OUNPAID PAID DATE ,ACCOUNT PERMIT ISSUANCE 101-0000-42404 0 .$91.85 $0.00 PA16 BY 'MM OD! EIPT i ICHECK 'W� 4" kc ITIO .T ORM m '__-REC. Total Paid for PERMIT ISSUANCE: $91.85 $0.06 5 Description: ELECTRRICAL CAR OUTTLET / BAKER CONDITIONS NAME TYPE Type: ELECTRICAL Subtype: Status: UNDER REVIEW Applied: 2/22/2016 RSE Approved: Parcel No: 762200025 Site Address: 80316 HERMITAGE LA QUINTA,CA 92253 Subdivision: PM 28489 Block: Lot: 2 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $665.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: CONTRACTOR VINTAGE E & S INC CHRONOLOGY CONDITIONS NAME TYPE NAME ADDRESSI CONTACTS CITY STATE ZIP PHONE FAX EMAIL APPLICANT. VINTAGE E & S INC 49950 JEFFERSON STREET 130-388 INDIO CA 92201 CONTRACTOR VINTAGE E & S INC 49950 JEFFERSON 'STREET 130-388 INDIO CA 92201 OWNER DEE BAKER 330 N ORCHARD DR I BURBANK I CA 1 92253 FINANCIAL INFORMATION Printed: Monday, February 22, 2016 4:29:31 PM 1 of 2 r SYS7Fti1S DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: APPLIANCES, RES 101-0000-42403 0 $12.09 1 $0.00 APPLIANCES, RES PC 101-0000-42600 0 $12.09 1 $0.00 Total Paid for ELECTRICAL: $24.18 $0.00 PERMIT ISSUANCE 101-0000-42404 0 $91.85 $0.00 Total Paid for PERMIT ISSUANCE: $91.85 $0.00 TOTALS:• 00 PARENT PROJECTS BOND INFORMATION ATTACHMENTS Printed: Monday, February 22, 2016 4:29:31 Plvi 2 of 2 or SYSTBtitS "''# City of La Quinta Buifding u Safety Division 78-495 Caffe Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit -Application and Tracking Sheet Permit # ProjectAddress; 9,02> 1-p 't2a^vvlt] _PY- Owner's Name: �-� A. P. Number: Address: �31 l,p t' �( v i Legal Description: City, ST, Zip: L-9, A ntra Co ctr: 0 i v� r, Tele hone• P Address: Project -Description: Atk,�l ,_s6A lsp City, ST, Zip: „� tl[-� t> > I(A Q `i—Z� e �� ✓ �, C a .r [ L\��('� �•�� e.11. Telephone: m 1 1 3 S S State Lic. # 13 2_ City Lic. #.: Arch., Engr., Designer: Address: City., ST, Zip: Tele h n e: � Con tr uction Type: ��-; Occu an cY State Lic. #: Alter Repair Demo Ject hPe �cit le ne). New Add'n AIto Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE H Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for corrections Plan Check Deposit Truss Caics. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction ' Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Revicvv, 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 I1OUSE:- Review, ready for correct ions/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 FEB 2 2 2016 CITY OF LA OUINTA COMMUNITY DEVELOPMENT