BSPN2017-0030s
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VOICE (760) 777-7125
78-495 CALLE TAMPICO
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FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253
DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT .
Date: 6/29/2017
Application Number: BSPN2017-0030
Owner:
Property Address: 78115 CALLE ESTADO STE 107
MILLER FAMILY HOLDINGS LLC
APN: 770152017
Application Description: NIETO / METER RELEASE
Property Zoning:
Application Valuation:
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Applicant:
Contractor:
STEVE NIETO
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78115 CALLE ESTADO #105
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LA QUINTA, CA 92253
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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 X Contractor:"
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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.).
(_J 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
WORKER'S CONDENSATION DECLARATION
I hereby affirm under penalty of perjur+one of the following declarations:
I have and will maintain a ce-tificate of consent to self -insure for workers'
compensation, as provided for by Sectian 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
I have and will maintain worcers' 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: _
_ 1 certify that in the performa ice 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 CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVICED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby mace to the Building Official for a permit subject to
the conditions and restrictions set forthon 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 owne-, 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 cessappn of work
for 180 days will subject permit to cancellation.
1 certify that I have read this application and state that the above infor do is correct.
I agree to comply with all city and counts ordinances and state law a 'n to building
construction, and hereby authorize representatives of this city to nt n the above-
mentioned property for inspection purp=)ses.
Date: Signature (Applicant or Agent):
Application Number: BSPN2017-0030
Property Address: 78115 CALLE ESTADO STE 107
APN: 770152017
Application Description: NIETO / METER RELEASE
Property Zoning:
Application Valuation:
Date: 6/29/2017
Owner:
MILLER FAMILY HOLDINGS LLC
Applicant: Contractor:
STEVE NIETO
78115 CALLE ESTADO #105
LA QUINTA, CA 92253
Llc. No.:
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Detail: ELECTRICAL RELEASE ONLY FOR STE 106.THIS PERMIT IN NOT FOR WORK. PER 2016 CALIFORNIA ELECTRGCAL CODES.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
SPECIAL INSPECTION 101-0000-42404 0 $76.00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $76.00