BPLB2016-0020111111 IIIII IIII IIII
12
79-495 CACLE TAMPICO • Ct a D � � . VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT. INSPECTIONS (760) 777-7153
BUILDING PERMIT
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- C27 License No.: 857801 i
D ate• • r �l�t �1 r!G Contr,act6
,+''f
OWNER -BUILDER ECLARATION
I hereby affirm under penalty of perjury th 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 4
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(1 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 contracto�(s) licensed pursuant to
the Contractors' State License Law.).
( ) 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
WORKER'S COMPENSATION DECLARATION
I her boy rm under penalty of perjury one of the following declarations:
IL I have and will maintain a certificate of consent to self -insure for workers'
mpensation, 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 polity number are:
Carrier: _ Polity 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 de, I shall forthwith
comply withthoseprovisions.
Date:2 ( / & Appy ant:
WARNING: FAILURE TO SECURE WORKERS' COMPENS ION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P ALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). 1 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 authorise representatives of this city to enter pon the
above-mentioned property for inspection purposes.
p
Dater ( C' Signature (Applicant or Agen
C%
Date: 1/27/2016
Application Number:
BPLB2016-0020
Owner:
Property Address:
56535 JACK NICKLAUS BLV
ANN HIGHSMITH
APN:
762070018
56535 JACK NICKALUS
Application Description:
HIGH SMITH; RUN 1" GAS LINE
LOS ANGELES, CA 92253
Property Zoning:
Application Valuation:
$800.00
Applicant:
BRIAN WESTLAKE LANDSCAPE INC
Contractor:
BRIAN WESTLAKECAPR& a
P 0 BOX 5175
P 0 BOX 5175
LA QUINTA, CA 92248
LA QUINTA, CA -922
JAN 2 7 2016
(760)250-2924
Llc.No.:857801 CITY OF LAQUIMTA
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- C27 License No.: 857801 i
D ate• • r �l�t �1 r!G Contr,act6
,+''f
OWNER -BUILDER ECLARATION
I hereby affirm under penalty of perjury th 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 4
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(1 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 contracto�(s) licensed pursuant to
the Contractors' State License Law.).
( ) 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
WORKER'S COMPENSATION DECLARATION
I her boy rm under penalty of perjury one of the following declarations:
IL I have and will maintain a certificate of consent to self -insure for workers'
mpensation, 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 polity number are:
Carrier: _ Polity 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 de, I shall forthwith
comply withthoseprovisions.
Date:2 ( / & Appy ant:
WARNING: FAILURE TO SECURE WORKERS' COMPENS ION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL P ALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). 1 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 authorise representatives of this city to enter pon the
above-mentioned property for inspection purposes.
p
Dater ( C' Signature (Applicant or Agen
C%
Bin # City of La Quin to
Buifding a Safety Division
Permit # 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
(, (p (�pj Building Permit Application and Tracking Sheet
ProjectAddress:R 4 CCC4G/(%lC4,�eCvs Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip: le"?
Contractor: r' all SI C/�
h(
T le honc:
Address: �) �� �/ 7�
Project Description: REw1 (t e(�......LC dl e.....
,
City, ST, Zip: L vi r 7�- ` (�/
2 Z ��
��iC� Q.
�P/�U t 1�`
7 CJ
.........
. ...Telephone: .
......
_
C n
State Lic.
CLic.#000
LP f
Cx/S�lt, o-vL (0
Arch., Engr., Designer:
Address:
City, ST, Zip:
ne:
Telephone:ho
.. ..........................
c
Occupancy:
Y Construction Type:
State Lt c. #
Project type (circle le ne : Nev Add'n Alter Repair Demo
Name of Contact Person: /�s(��
Sq. Ft.:
# Stories,:?
# Units:
Telephone # of Contact Person: 7l U � 2 SO Z 2
Estimated Value of Project: pw
APPLICANT: DO NOT WRITE BELOW THIS LINE
H
Submittal
Req'd
Rce'd
TRACKING
PERMIT PEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
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
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
Subconlactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review, 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
a
FINANcIAL'INFORM
1
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DESCRIPTON = ACCOUNT AM
... QTY 3
BSAS SB1473 FEE 101-0000-20306
0 $1.00 $1.00 1/27/16
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PAIDD.
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BRIAN WESTLAKE LANDSCAPE INC DEBIT'
R12379 000003 TSA'
Total Paid for BUILDING STANDARDS ADMINISTRATION, BSA: $1.00 $1.00
' } DESCRIPTIONf
T�5YgAMOUNT
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PAID DATE
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'PERMIT ISSUANCE . -
101=0000-42404.
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$91.85
$91.85,
1/27/16
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BRIAN WESTLAKE LANDSCAPE INC ,
DEBIT
R12379
000003
TSA
Total Paid for PERMIT ISSUANCE: $91.85 $91.85
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;9'
OUNT
PAID
PAID DATE
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.
GAS SYSTEM, 1-4 OUTLETS
101-0000-02401
0.
$12.09.
$12.09
1/27/16
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s PAID BY
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RECEIPT #r f
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BRIAN WESTLAKE LANDSCAPE INC
DEBIT
R12379
000003
TSA
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DESCRIPTION k
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QTY
PAIDO ATE
GAS SYSTEM, 1-4, OUTLETS PC
101-0000742600
0
$24.17
$24.17
1/27/16
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PAID,BY
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BRIAN WESTLAKE LANDSCAPE -INC
DEBIT
R12379
000003
TSA
Total Paid for:PLUMBING FEES: '$36.26 $36.26
Permit Number: BPLB2016-0020
Applied: 1/27/2016
Issued:
Status: APPROVED
Parent Permit:
Parent Project:
Details:
Approved:1/27/2016
Finaled:
Description: HIGH SMITH; RUN 1" GAS LINE.
Site Address: 56535 JACK NICKLAUS BLV
City, State Zip Code: LA QUINTA, CA 92253
Applicant: BRIAN WESTLAKE LANDSCAPE INC
Owner: ANN HIGHSMITH
Contractor: BRIAN WESTLAKE LANDSCAPE INC
PLUMBING - (3) GAS OUTLETS. 2013 CALIFORNIA BUILDING CODES.
LIST OF
SENT DATE RETURNED DUE DATE TYPE CONTACT STATUS REMARKS
DATE
-7
Review Group: BLDG 1ST (1WK)
1/27/2016
1/27/2016
1/27/2016
1ST BLDG NS (1 WK)
LUIS URIBE
APPROVED
Notes:
Printed: Wednesday, 27 January, 2016 1 of 1 er
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