BSPN2018-000378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
SPECIAL INSPECTION/
13SPN2o18-0003
`&N' °F 4Qulxfw
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
81644 ANDALUSIA "
764670016
SPECIAL INSPECTION FOR GAS RELEASE
Applicant:
T D DESERT DEVELOPMENT LIMITED PARTNERSH
81570 CARBONERAS FEB 0 6 2018
LA QUINTA, CA 92253
CITY OF LA QUINTA'
DESIGN AND DEVELOPMENT DEPARTMENT
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 Cla s: License No.:
Date: Z 7,"QContra
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contract res 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 Address:
VOICE (760) 777-7125 .
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/7/2018
Owner:
T D DESERT DEV
81570 CARBONERAS
LA QUINTA, CA 92253
Contractor:
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 provided for by Section 3700 of the Labor Code, for the performance
of e w r or w ich this permit is issued.
I have d will maintain workers' compensation insurance, as required by
ch this permit is
Se 3700 of th Labor Code, for the performance of the work for whi
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 bec subject to the
workers' compensation provisions of Section 3700 of th or Co , I shall forthwith
comply with t t,
se pr visions.
Date: Z Applicant:
WARNING: FAILURE TO.SECURE WORKERS" COM PENSATION COVERAGE IS UN WFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINE 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 ordinan7ofthis
a ws relating to building
construction, and hereby authorize represents ' city to enter upon the above-
mentioned mpe for inspection purposesDate: / ! � Signature (Applic nt or
"
Date: 2/7/2018
w
Application Number: BSPN2018-0003
"Owner:
Property Address: 81644 ANDALUSIA
T D DESERT DEV
APN: 764670016
81570 CARBONERAS
Application Description: SPECIAL INSPECTION FOR GAS RELEASE
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
Applicant:
Contractor:
T D DESERT DEVELOPMENT LIMITED PARTNERSH
81570 CARBONERAS
LA QUINTA, CA 92253
Llc. No.:
Detail: SPECIAL INSPECTION FOR GAS RELEASE FOR SOCAL GAS TO INSTALL METER PER AJ
FINANCIAL •••
DESCRIPTION ACCOUNT CITY AMOUNT
SPECIAL INSPECTION 101-0000-42404 0 $78:00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $78.00
TOTALS:0�