BSPN2015-0057-Cu"
72
4 � Qum&
VOICE (760) 777-7125
78-,495:C.411F.TANIPICO„
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FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
-
-
Date: 12/2/2015
Application Number: BSPN2015 0057
Property Address: 77110 VISTA FLORA
))` ,�/ Owner:
jEL = =LINDA PATR�,`pi�
APN: 658390074
J ,9 #41140 FORT
I
ST
Application Description: PATRY RESIDENCE/ SPECIAL INSPECTION `-'d !d �V�C�TORIA 3��CANADA
V8V,K8
Property Zoning:
p�
Application Valuation:
Applicant:
Contredo�:�
LINDA PATRY
#4 1140 FORT ST
VICTORIA BC CANADA V8V, K8
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 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, 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 am exempt under Sec. B.&P.C. for this reason
Date: ' 2 iS� 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 Add
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, 1
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 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.
construction, and hereby authorize representatives of this city to enter upon the
above-mentioned property for inspection purposes.
Ate: Signature (Applicant or Ageo.
FINANCIAL INFORMATION
�x� f�..wx• up6yCR4PTION ACCOUNT
C+TY AMOUNT PAID
PAID DATE
SPECIAL INSPECTION 101-0000-42404
0 $72.52 $72.52
12/2/15
PAID By. METHOD
4' RECEIPT•# CHECK#
CLTD BY
LINDA PATRY CASH
R11243
MFA
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $72.52 $72.52
•
Description: PATRY RESIDENCE / SPECIAL INSPECTION
Type: SPECIAL INSPECTION
Subtype:
Status: ISSUED
Applied: 12/2/2015 MFA
Approved: 12/2/2015 MFA
Parcel No: 658390074 Site Address: 77110 VISTA FLORA LA QUINTA,CA 92253
Subdivision: TR 28545-2
Block:
Lot: 1
Issued: 12/2/2015 MFA
Lot Sq Ft: 0
Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $0.00
Occupancy Type:
Construction Type:
Expired: 5/30/2016 MFA
No. Buildings: 0
No. Stories: 0
No. Unites: 0
K8
Details:
(250)896-3539
CONDITIONS
CONTACTS
NAME TYPE
NAME
ADDRESSI
CITY
STATE
ZIP
PHONE,
FAX
EMAIL
APPLICANT
LINDA PATRY
#4 1140 FORT ST
VICTORIA BC
CANADA V8V .
K8
(250)896-3539
OWNER
LINDA PATRY
#4 1140 FORT ST
VICTORIA BC
CANADA V8V
K8
(250)896-3539
Printed: Wednesday, December 02, 2015 1:00:29 PM 1 of 2
RSYSTEti15
INSPECTIONS
Printed: Wednesday, December 02, 2015 1:00:29 PM 2 of 2 Ci?W
SYSTEMS
Bin #
Permit #>!
Project Address: '") �) ()
City of La Quinta .
Building 8t Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
(S D leh Owner's Name:
A. P. Number:
Address:'-- 0 p
Legal Description:
City, ST, Zip;
Contractor:
Telephone: a -
5 35
Address:
Project Description:
City, ST, Zip:
/%,%C:.
, c ' !G. /CSLe,,l
Telephone:
P
State Lie. # :
City Lie. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
....................................
e• Pan
Construction lTYOccupancy:
P cY
State Lie. #.
Project (circlele one • New A dd'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
!t
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact PersonPlan
Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan .
2" Revicw, ready for corrections/issue
Electrical
l
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
'
II.O.A. Approval
Plans resubmitted
Grading
IN DOUSE:-
"Review, ready for correctionslissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees
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