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BURL2017-0001LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that,l 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.l 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: 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 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of fie following declarations: I have and will maintain a certificate :)f 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' corn pensation 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 =arrier 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: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINA, PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001 IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR 1 J SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWP.EDGEMENT IMPORTANT: Application is hereby made to the 3uilding 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 applicaton 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 cancellason. 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 ordina ices and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the Q above-mentioned property for inspection purposes.. /\ J Date: // Signature (Applicant or.Agent)/ VOICE (760) 777-7125 78-495 CALLE TAMPICO V FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 . BUILDING PERMIT Date: 2/1/2017 Application Number: BURL2017-0001 Owner: Property Address'. 53240 AVENIDA ALVARADO HABITAT FOR HUMANITY APN: 774044012 34470 GATEWAY DR Application Description: HABITAT FOR HUMANITY / IID RELEASE PALM DESERT, CA 92211 Property Zoning: Q z Application Valuation: 6 ti a Applicant: Contractor: w ©' N ~ " 0LU HABITAT FOR HUMANITY - DAVE THORNTON ry CyLU 34470 GATEWAY DR O S o PALM DESERT, CA 92211 Q v Lt, 2 Llc. No.: --------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that,l 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.l 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: 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 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of fie following declarations: I have and will maintain a certificate :)f 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' corn pensation 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 =arrier 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: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINA, PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001 IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR 1 J SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWP.EDGEMENT IMPORTANT: Application is hereby made to the 3uilding 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 applicaton 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 cancellason. 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 ordina ices and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the Q above-mentioned property for inspection purposes.. /\ J Date: // Signature (Applicant or.Agent)/ Date: 2/1/2017 Application Number: BURL2017-0001 Owner: Property Address: 53240 AVENIDA ALVARADO HABITAT FOR HUMANITY APN: 774044012 34470 GATEWAY DR Application Description: HABITAT FOR HUMANITY / IID RELEASE PALM DESERT, CA 92211 Property Zoning: Application Valuation: Applicant: Contractor: HABITAT FOR HUMANITY - DAVE THORNTON 34470 GATEWAY DR PALM DESERT, CA 92211 Llc. No.: --------------------------------------------------------------------------------------------- Detail: ELECTRICAL RELEASE FOR IID. THIS PERMIT IS NOT FOR WORK. 2016 CALIFORNIA BUILDING CODES. x Total Paid for TECHNOLOGY ENHANCEMEN- FEE: $5.00 3 FINANCIAL r.�. DESCRIPTION •• • ACCOUNT QTY AMOUNT Credit Card Fee 101-0000-43505 0 • $1.46 Total Paid for Credit Carc Fee: $1.46 DESCRIPTION ACCOUNT QTY AMOUNT ELECTRICAL- UTILITY RELEASE 101-0000-42400 0 $76.00 Total Paid for ELECTRICAL - UTILITY RELEASE: $76.00 DESCRIPTION ACCOUNT aTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 x Total Paid for TECHNOLOGY ENHANCEMEN- FEE: $5.00 3 Bin ## Permit ## Project Address: e�U City of La Qu«nta 6uifding 8F Safety Division 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701,2 Building Permit Application and Tracking Sheet Fitil `. Owner's Name: G V A. P. Number: Address: 3L f Lt/ �0DOR Legal Description: City, ST, Zip: P%Iz4" Contractor: T elePhonc. C U Address: Project Description: v City, ST, Zip: Telephone: e h Po . State Lic. # : City Lie. #t Arch., Engr., Designer. Address: City, ST, Zip: Telephone: Construction n TYPe: Occupancy: : to S toi . L c t.. • :' Project type (circle one):. New Add'n Aster Repair. Demo. Name of Contact Person: G Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: 7 —W 3CP Estimated Value of Project: APPLICANT: DO' NOT WRITE BELOW THIS LINE t/ Submittal Re q'd Rcc'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cates. Reviewed, ready for corrections Plan Clieck Deposit Truss Calcs. Called Contact Person Plan Check Balance. Title 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. II.O.A. Approval Plans resubmitted Grading IN HOUSE:- 'r° Review, ready for corrections/issue Developer Impact Fee Planning Approval. Called Contact Person A.I.P.P. Pub. NVks. Appr Dale of permit issue School Fees, Total Permit Fees SyS5 'M DEQ WY IUCQC-t ilk: M_ ,��dV �ffO �1��. 1 1 25 � ao r�FsS �,� ELECTRICAL - UTILITY (IID) RELEASE- PERMIT --INSTRUCTIONS HELLO AND WELCOME! `.Thank you for choosing our :efficient and time -saving online permitting system. The following instructions have been provided to aid= and assist you throughout the permitting process with your Electrical Utility (IID) Release Permit. _ REQUIRED INFORMATION: 1. Owner Information: -Name - AddressL 3 -Email �x��,,T1 lI� Q i�2,C Cc ori, Old -Telephone 76D -qvl_. (99 n X -,01 2. Applicant Information -Name 1DhV� i l�v�Rti-To� �?N r i"1.yU�EyOl2-3 -Email -Contact telephone SaV&C x REVIEW PROCESS: No review will be required as this permit is not for construction. Permits wil be available to be issued 100% online: INSPECTION PROCESS: To schedule an inspection: 1. Log in to the eTRAKiT portal. 2. Click "Schedule" under the Inspections Tab. 3. Select your permit. 4. Click "Request Inspection" next to the green,icon. 5. Fill out all required fields and click "Add Inspection." 6. Your inspection details will then be visible under the blue tab toward the bottom of the page. Utility (IID) Release" - may be scheduled at any time. Please make sure there is no exposed wiring,.and the entire electrical system is in a state to be re -energized. Additionally, please make sure the grounding electrode (i.e. Ufer ground, ground rod, etc.) are accessible and visible at the time of inspection. NOTE: NO JOB CARD WILL BE ISSUED FOR YOUR PERMIT. IN ORDER TO CHECK INSPECTION REQUESTS, INSPECTION STATUSES, AND NOTES REGARDING INSPECTIONS, FOLLOW THESE INSTRUCTIONS: 1: Log in to the Lo Quinta Public Portal 2. Log in with your Username and Password 3. Navigate to the Dashboard 4. Click on your permit under the "My Active Permits" section 5. Select the "Inspections" tab 6. Locate the inspection to view the status. To view notes about specific . inspections, click "More Info"