BSPN2018-00014
1 - 95.&'LL1 TAMPJLO
LA QUINTA, CALIFORNIA'92253 DESIGN & DEVELOPMENT DEPARTMENT,
BUILDING PERMIT
Permit Type/Subtype: SPECIAL INSPECTION/
Application Number:
BSPN2018-0001
Property Address:
76986 CALLE MAZATLAN
APN:
658161032
Application Description:
DAVID MOSS SPECIAL INSPECTION
Property Zoning:
Application Valuation:
Applicant:
DAVI D'MOSS
6822 SCENIC BAY SR.
HUNTINGTON BEACH, CA 92648
JAN 0 4X018
CITY OF LA QUINTA
COMMUNITY 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 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 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: U
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/4/2018
Owner:
DAVID MOSS
6822 SCENIC BAY SR
HUNTINGTON BEACH, CA -92648
Contractor:
Lic. 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, 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' 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 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 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 dated. 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 abo i formation is correct.
I agree to comply with all city and county ordinances and stat a relating to building
construction, and hereby authorize representatives of this citto nter upon the above-
mentioned property for inspection purposes.
l
OW: Signature (Applicant or Agent):
Date: 1/4/2018
Akplication.Number::.,, BSPN2018 0001
Owner:
Property Address: '^ ' `76986 CALLE MAZATLAN
DAVID MOSS
. APN: 658161032
6822 SCENIC BAY SR
Application Description: DAVID MOSS SPECIAL INSPECTION
HUNTINGTON BEACH, CA 92648
Property Zoning:
Application Valuation:.
Applicant:
Contractor:
DAVID MOSS
6822 SCENIC BAY SR
HUNTINGTON BEACH, CA 92648
LIc. No.:
----------------------------------------------------------------------------------------------
Detail: SPECIAL INSPECTION REQUIRED TO VERIFY SCOPE OF UNPERMITTED WORK PER CODE CASE 17-2529 [MOISES RODARTE], SPOKE WITH OWNER
' AND HE WILL BE COMING IN TO OBTAIN PERMIT FOR INSPECTION AND. WILL SCHEDULE A TIME TO BE ONSITE. SPECIAL INSPECTION ONLY. DOES NOT
INCLUDE WORK.
DESCRIPTION
FINANCIAL •L,
ACCOUNT CITY
AMOUNT
SPECIAL -INSPECTION
101-0000-42404 0
$78.02
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$78.02
DESCRIPTION
IF
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
�a
10,
PERMIT# ZO GOI
PLAN LOCATION:
Project Address:. �� �O C� /�„-�� ��•,�
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN
City, St, Zip
Garage
SF.
Applicant Name: 4� .
Patio/Porch
Address: Z sce/61C _
Email:
City, ST, Zip:
SF
Telephone:
Email: �' ,(j LFAJ S,
Valuation of Project $
Contractor Name:
New SFD Construction:
Address:
Address:
Conditioned Space
SF
City, St, Zip
Garage
SF.
Telephone:
Patio/Porch
SF
Email:
Fire Sprinklers '
SF
State Lic: City Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Construction Type: Occupancy:
' Telephone:
Bedrooms:
Stories:
# Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name:
New Commercial /Tenant Improvements:
Address:
Total Building SF
City,' ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
-'Submittal
Req'.d
-Rec'd
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
`
Grading Plan (PM 10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License