BWFE2016-002201
Applicant:
RICE CONSTRUCTION
44701 SAN JOSE
PALM DESERT, CA 92260
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: B License No.: 852723
Date:. '121J, � N_Contractor: ��(,,Q G,Q"SkTuuboy\-
Contractor: ,.
RICE CONSTRUCTION ,
44701 SAN JOSE r
PALM DESERT, CA 92260 k
(760)408-6426 !. -
Llc. No.: 852723
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.
'V__ 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:
i
t
OWNER -BUILDER DECLARATION
Carrier: — Policy Number: _
QuArcu
VOICE (760) 777-7125
78-495 CALLE TAMPICO
shall not employ any person In any manner so as to become subject to the workers'
D "` "
compensation laws of California, and agree that, If I should become subject to the
LA QUINTA, CALIFORNIA 92253
workers' compensation provisions of Section 3700 of the labor Code, I shall forthwith
FAX (760) 777-7011
comply with those provisions.
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
Date: D `� _ Applicant:
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
BUILDING PERMIT
permit subjects the applicant to a civil penalty of not more than five hundred dollars
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
Date: 3/17/2016
Application Number:
BWFE2016-0022
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
Owner:
Property Address:
51317 MADISON ST
DESERT POLO LAND COMPANY, LLCM -i-,—"'
APN:
777030003
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
405 S. BEVERLY DR - f
Application Description:
DESERT POLO LAND / BLOCK
WALL 1728 LFAND 2 ENTRY GATES
BEVERLY HILLS, CA 90212
Property Zoning:
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application , the owner, and the applicant, each agrees to, and
1
Application Valuation:
$77,000.00
employees for any act or omission related to the work being performed under or
the Contractors' State Ucense Law.).
Applicant:
RICE CONSTRUCTION
44701 SAN JOSE
PALM DESERT, CA 92260
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: B License No.: 852723
Date:. '121J, � N_Contractor: ��(,,Q G,Q"SkTuuboy\-
Contractor: ,.
RICE CONSTRUCTION ,
44701 SAN JOSE r
PALM DESERT, CA 92260 k
(760)408-6426 !. -
Llc. No.: 852723
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.
'V__ 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:
i
t
OWNER -BUILDER DECLARATION
Carrier: — Policy Number: _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
_ I certify that In the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person In any manner so as to become subject to the workers'
city or county that requires a permit to construct, atter, improve, demolish, or repair
compensation laws of California, and agree that, If I should become subject to the
any structure, prior to Its Issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Section 3700 of the labor Code, I shall forthwith
signed statement that he or she Is licensed pursuant to the provisions of the
comply with those provisions.
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
Date: D `� _ Applicant:
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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
(�I I, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,GD0). iN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
are not Intended or offered for sale. If, however, the building or Improvement Is sold
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application. .
he or she did not build or Improve for the purpose of sale.).
1. Each person upon whose behalf this application Is made, each person at whose
(_)1, as owner of the property, am exclusively contracting with licensed contractors,
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who bullds or Improves
shall defend, Indemnify and hold harmless the City of La Quanta, Its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
employees for any act or omission related to the work being performed under or
the Contractors' State Ucense Law.).
following Issuance of this permit.
I I am exempt under Sec. . 8.8tP.C. for this reason
2. Any permit Issued as a result of this application becomes null and vold 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.
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 Address: `. 1
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 relatin o building
construction, and hereby authorize representatives of this city to enter u n the
above-mentioned property for Inspection purposes. •
Date:, •� �� i Signature (Applicant or Agent):IF
._