BSPN2017-0029LICENSED 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 ) 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.).
(� 1, 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 Na
Lender's Address:
WORKER'S COMP=NSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certficate of consent.to self -insure for workers'
compensation, as provided for by Sectior 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
_ I have and will maintain works' 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, 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 1 should become subject to the
workers' compensation provisions of Sect.on 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 CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($10.7,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDEDIFOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACP NOWLEDGEMENT
IMPORTANT: Application is hereby made t) 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, avid 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 csation of work
for 180 days will subject permit to'cancellaton.
I certify that I have read this application andstate that the above in4W Wtingto
tiiect.
I agree to comply with all city and county or8inances and stateng
construction, and herebyauthorize representatives of this yve-
mentioned p for inspection purposes
Date: Signature (Applicarc or Agent):
Twi4 09&r(u
VOICE (760) 777-7125
78-495 CALLE TAMPICO
U4
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 6/29/2017
Application Number: BSPN2017-0029
Owner:
Property Address: 78115 CALLE ESTADO STE 106
MILLER FAMILY HOLDINGS LLC
APN: 770152017
Application Description: NIETO / METER RELEASE
e�
Z
Property Zoning:
i, a
Application Valuation:
N
Applicant:
Contractor.
STEVE NIETO
::D
78115 CALLE ESTADO #105
LA QUINTA, CA 92253
&
Llc. No.:
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 ) 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.).
(� 1, 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 Na
Lender's Address:
WORKER'S COMP=NSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certficate of consent.to self -insure for workers'
compensation, as provided for by Sectior 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
_ I have and will maintain works' 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, 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 1 should become subject to the
workers' compensation provisions of Sect.on 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 CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($10.7,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDEDIFOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACP NOWLEDGEMENT
IMPORTANT: Application is hereby made t) 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, avid 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 csation of work
for 180 days will subject permit to'cancellaton.
I certify that I have read this application andstate that the above in4W Wtingto
tiiect.
I agree to comply with all city and county or8inances and stateng
construction, and herebyauthorize representatives of this yve-
mentioned p for inspection purposes
Date: Signature (Applicarc or Agent):
Date: 6/29/2017
Application Number: BSPN2017-0029 Owner:
Property Address: 78115 CALLE ESTADO STE 106 MILLER FAMILY HOLDINGS LLC
APN: 770152017
Application Description: NIETO / METER RELEASE
Property Zoning:
Application Valuation:
Applicant: Contractc r:
STEVE NIETO
78115 CALLE ESTADO #105
LA QUINTA, CA 92253
J
Llc. No.:
--------------------------------------------------------------------------------------------'
Detail: ELECTRICAL RELEASE ONLY FOR STE 106.THIS PERMIT IN NOT FOR WORK. PER 2016 CALIFORNIA ELECTRICAL CODES.
i
INFORMATION,FINANCIAL
DESCRIPTION ACCOUNT CITY AMOUNT
SPECIAL INSPECTION 101-0000-42404 0 $76.00
Total Paid for COMPLIANCE SURVEY/SPECIAL NSPECTION: $76.00
TOTALS:00
Bin#
Qty Of La- Quinta.
Building & Safety Division
r
78-495 Calle Tampico
/-lJ��� �—"�
Quinti, CA 92253.- (760):777-7012
a-:Z,uilding Permit Application and Tracking Sheet
Permit # , � ��
Proj'eec�t-C' cess:
A. P. Number:
_FAdd
Legal Description:
Gomracto
;'Tel h .
ep
Address: 1Mroject,Descrptiorr.
1113
City, ST, Zip:,,'
.� .
Telephone:
State Lic: # :
City Lic. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone: h
one:
f:
'`State
:. .:.
n
Co tru
s ction T yP e: Occupancy:
P �7'=
Lic. #:
Project type (circle one New Add'n Alter Repair Demo
e of C_otltact Eerson. �O
/
.. '1&'
S4.
#Stories:
#Units:
Tccphone # oPCoritact Person: 7 '
ffiinated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss talcs.
Called Contact Person
Plan Check Balance
+
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
'
Grading plan
2wd Review, ready for corrections/issue
Electrical "
Subcontactor List
Called Contact Person
Plumbing ,
Grant Deed
Plans picked up'
S.M.I.
H.O.A: Approval
Plans resubmitted
Grading
IN HOUSE:-
3,d 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
P