BPLB2017-013878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
PLUMBING/
Application Number:
BPLB2017-0138
Property Address:
43990 GENOA. DR
APN:
609511014
Application Description:
BULSKI RESIDENCE /
Property Zoning:
Application Valuation:
$14,000.00
Applicant:
XQUIZIT HOME IMPROVEMENT
9700 HOYLAKE RD
DESERT HOT SPRINGS, CA 92240
Tdy
4 „ auiw
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
D �-
0 C T 19 2017
BI NG�CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPAWMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed and pr sio f Chapter
9 (commencing with Section 7000) of Division 3 of the Busi ss Pr ons Code,
and my License is in full force and effect.
License Class: B License No.: 979831
D el �Contcactori
OWNER -BUIL E E LARAJ N
I hereby affirm under penalty of perjury t at I a xemromthe 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 -1
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.).
(_) 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
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/19/2017
Owner:
WALT BULSKI
43990 GENOA
LA QUINTA, CA 92253
Contractor:
XQUIZIT HOME IMPROVEMENT
9700 HOYLAKE RD
DESERT HOT SPRINGS, CA 92240
(760)408-5488
Llc. No.: 979831
WORKER'S COMPENSATON DECLARATION
I hereby affirm under penalty of perjury one otlthe following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 370C of the Labor Code, for the performance -
of the k for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Se ion 3700 of the Labor Code, for the performance of the work for which this permit
is i sued. My workers' compensation insuranc carrier and policy number are:
Carrier: NORGUARD INSURANCE COMPANY Policy Number: CAWC856071
I certify that in the performance of -he work for which . permit i su d, I
shall not employ any person in any manner so as to become s
/he rker 'compensation laws of California, and agree thet, if I should ecto t
workers' compensation provisions of Section 3200 of th ab II f hwith
comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' Cl5r APE ATICOVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIhA ENAL ES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,0 . IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOF 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 thi! 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 tie 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 ssuance of such permit, or cessation of
work for 180 days will subject permit to cancel ation.
I certify that I have read this application and state that the above /ee
I agree to comply with all city and county ordinances and state la
construction, and hereby authorize representatives of this cit
above-mentionedirproperty for inspection purposes.
Signatu�e(Appl� icantor
i
Date: 10/19/2017
Application Number: BPLB2017-0138
Owner:
Property Address: .43990 GENOA DR
WALT BULSKI
APN: 609511014
43990 GENOA
Application Description: 'BULSKI RESIDENCE/ PLUMBING
LA QUINTA, CA 92253
Property Zoning:
Application Valuation: $14,000.00
Applicant:
Contractor:
XQUIZIT HOME IMPROVEMENT*
XQUIZIT HOME IMPROVEMENT
9700 HOYLAKE RD
9700 HOYLAKE RD
DESERT HOT SPRINGS, CA 92240
DESERT HOT SPRINGS, CA 92240
(760)408-5488
Llc. No.: 979831
Detail: REMOVE AND REPLACE EXISTING SHOWER AND TUB. PER 2016 CALIFORNIA BUILDING CODE
FINANCIAL .• 1•
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$98.83
Total Paid for PERMIT ISSUANCE: $98.83
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$26.00
DESCRIPTION
ACCOUNT
-QTY
AMOUNT
FIXTURE/TRAP PC
101-0000-42600
0
$26.00
Total Paid for PLUMBINE FEES: $52.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-424160
$10.00
Total Paid for RECORDS MANAGEMENT FEE: $10.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin#
City of La Quinta
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 = (760) 777-7012
Building Permit Application and Tracking Sheet
Permit#
Project Address:
Owner's Name:
A.P. Number
Address:
oma.
Legal Description:
City, ST, Zip:
Contractor:
Telephone:
Address:
Project Descrip on:
City, ST, Zi
_
'fes w
Y
Telephone:
�n /
State Lic. #:
City Lic #:
Arch, Engr., Designer:
J
Address:
f
L
City, ST, Zip:
Telephone:
Construction Type:
Occupancy:
State Lic. #:
Prej. Type
New
Add'n
Alter
Repair.
Demo
Name of Contact:
SgFt:
#Stories
# Units:
Telephone of Contact:
_
Estimated Value of Project:
&LI:
APPLIC NT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Calcs
Reviewed, ready for corrections .
Plan Check Deposit:
Truss Calcs
Called Contact Person
Plan Check Balance:
Title 24 Calcs
Plans Picked Up
Construction:
Flood Plain Plan
Plans Resubmitted
Mechanical:
Grading Plan
2nd Rev, Ready for corrections /
Electrical:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading
IN-HOUSE
3rd Rev, Ready for corrections /
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Apps
Date of permit issue
School Fees
Total Permit Fees
IN
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Ago
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CITY OF LA QUINA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONST UCTION
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