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BSPN2016-003178-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 c&r 4 4Qub& COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BSPN2016-0031 Property Address: 79485 HIGHWAY 1113 APN: 600020027 Application Description: WILLIAM / IID ELECTRICAL RELEASE Property Zoning: Application Valuation: Applicant: WILLIAM NYMAN 79364 CALLE VISTA VERDE LA QUINTA, CA 92253 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 avid Professions Code, and my License is in full force and effect. License Class: License No.: Date: // G L//(— 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).: (� 1, 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 theough 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 Name: Lender's Address: 52 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: RABO BANK 74760 HIGHWAY 111 ST 200 INDIAN WELLS, CA 92253 Contractor: LIC. No.: Date: .3/22/2016 Fin J P �A;� 2 2 2016 COMilut4'.TIOEVEiCt-','��Efl�'OEP;V� , 'ENT 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: �` ZZ! l� Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION =CIV11FINES WFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES P 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 �pproperty for inspection purposes. k,",& ` Date: �� I _ Signature (Applicant or Agent): DESCRIPTION FINANCIAL INFORMATION ACCOUNT' "" QTY AMOUNT PAID PAID DATE' SPECIAL INSPECTION 101-0000-42404 0 $72.52 $72.52 3/22/16 PAID BY METHOD %RECEIPT # .: CHECK # CLTD BY WILLIAM NYMAN DEBIT R14076 RSE DESCRIPTION ACCOUNT QTY. AMOUNT, : PAID PAID.DATE SPECIAL INSPECTION PC 101-0000-42600 0 $181.29 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $253.81 $72.52 Description: WILLIAM / IID ELECTRICAL RELEASE • Type: SPECIAL INSPECTION Subtype: Status: UNDER REVIEW Applied: 3/22/2016 RSE Approved: Parcel No: 600020027 Site Address: 79485 HIGHWAY 1113 LA QUINTA,CA 92253. Subdivision: PM 33588 Block: Lot: 1 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 79364 CALLE VISTA LA QUINTA VERDE Details: SPECIAL INSPECTION ELECTRICAL RELEAS. NOT FOR ANY WORK. 92253 CHRONOLOGY • NAME TYPE• NAME CONTACTS ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT WILLIAM NYMAN 79364 CALLE VISTA LA QUINTA VERDE CA 92253 OWNER RABO BANK 74760 HIGHWAY 111 INDIAN WELLS STE 200 CA 92253 ATTACHMENTS Printed: Tuesday, March 22, 2016 10:08:28 AM 2 of 2 CBFtJ L✓ SYSTEMS Bin'# City of La Quinta Building 9 Safety Division . . 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit #I S fJ'2A I - Project Address: iq t l , V f v O%vner's Name:M4114 00 A. P. Number: Address: --70/ t ,/ ql Legal .Description: City, ST, Zip: (� 0.;,1 � C &'Z 2 l; a /L7 n-1 Tcienl o iel ....r.ri Address: 2C Q 6 4 it <_ U_ 7.ie V d 4, Project Description: t"C11-t G A C City, ST, Zip: L � iZ Z; ( k Telephone: % State Lic. # : City Lac. #: Arch., Engr., Designer: Address: _ O /ln City, ST, Zip: ,. Telephone: :-:. �.,��...o ��:�-��.< a,�y,�` rw.:, ;:3'>:n:y Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo State Lic. #: Name of Contact Person: Sq. Ft;; Zly /3 #Stories;_ j # Units. Telephone # of Contact Person: Estimated Value of Prc i=t: APPLICANT: DO NOT WRITE BELOW THIS LINE ` 11 Submittal Req'd Rcc'd TRACKING PERMIT FEES Plan Sets Pian Check submitted _ Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Cates. Plans picked up Construction ' Flood plain plan Plans resubmitted Meehanical Grading plan 2°` Review, ready for correctionslissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Pians picked up S.M.I. If.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date. of permit issue Scho s, Total Permit Fees