BRES2015-013778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:.
Application Description:
Property Zoning:
Application Valuation:
Applicant:
DISCOVERY BUILDERS
80955 AVENUE 52
LA QUINTA, CA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BRES2015-0137
81266 PEARY PL
767680032
T -STAR RESIDENCE REVISIONS WHILE UNDER CONSTRUCTION
$12,000.00
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.: AEC252
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, 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 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 Address:
VOICE.(760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 7.77-7153
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
o k for which this permit is issued.
ave 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.
O
Date: 510- -5i Applicant: !v7
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 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 ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above•
mentioned property for inspection purposes.
Date: veys Signature (Applicant or Agent):
Date:
5/18/2015
Owner:
T -STAR STAR LLC
2030 E FLAMINGO RD #290
LAS VEGAS, NV 89119
.
Contractor:
m
to .
DISCOVERY BUILDERS
n
C
80955 AVENUE 52
m y
LA QUINTA, CA 92253
(760)393-5286
Llc. No.: AEC252
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
o k for which this permit is issued.
ave 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.
O
Date: 510- -5i Applicant: !v7
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 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 ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above•
mentioned property for inspection purposes.
Date: veys Signature (Applicant or Agent):
DeiCRIPT16N*
INF.0,11MATION-
: ACCOUNT ` ""`
QTY AMOUNT
PAID
PAID DATE'
ADDITION, EA ADDITIONAL 500 SF
101-0000-42400
0 $62.36
$0.00
PAID BY .; ,.:
METHOD
RECEIPT # "
CHECK #
CLTD BY
" DESCRIPTION' `
'.'' ACCOUNT
QTY'
AMOUNT
- ' PAID
PAID DATE
ADDITION, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$17.40
$0.00
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION ` r*
ACCOUNT •
,QTY
- AMOUNT
u
•PAID
•PAID DATE'
ADDITION, FIRST 100 SF
101-0000-42400
0
$120.83
$0.00
PAID BY -
METHOD
-
RECEIPT #
CHECK #
CLTD BY
DESCRIPTION
ACCOUNT ,QTY
AMOUNT Y
PAID
PAID DATE
ADDITION, FIRST 100 SF PC
101-0000-42600
0
$171.14
$0.00
'PAID BY '.
METHOD -
iREC.EIPT #
CHECK # .
CLTD BY':_
Total Paid forADDITION: $371.73 $0.00
DESCRIPTION. '°
ACCOUNT
_QTY
AMOUNT' `
PAID
PAID DATE
HOURLY PLAN CHECK - ESG
101-0000-42600
2
$196.00
$0.00
PAID BY
METHOD _
; . RECEIPT V:
CHECK ti
CLTD BY
Total Paid for BLDG CITY STAFF - PER HOUR: $196.00 $0.00
.DESCRIPTION :
ACCOUNT
QTY
AMOUNT_
xPAID : -
PAID DATE
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00 ..
PAID BY
METHOD
RECEIPT # k
CHECK # ,
CLTD BY -_
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
r; :DESCRIPTION.>
ACCOUNT.
QTY-
AMOUNT..,,
PAID DATE
RESIDENTIAL, FIRST 1,000SF
101-0000-42403
0
$145.03
$0.00.
,4,PAID' BY . ;':
*: .METHOD
_ 'RECEIPT #
°. CHECK #
CLTD BY
" DESCRIPTION
ACCOUNT `.
QTY
.. AMOUNT
PAID
PAID DATE
RESIDENTIAL, FIRST 1,000SF, PC
101-0000-42600
0
$47.86
$0.00
PAID: BY
METHOD ',
" RECEIPT #'C
HECK .
CLTD BY;,
Total Paid forELECTRICAL - NEW CONSTRUCTION: $192.89 $0.00
„ DESCRIPTION,
ACCOUNT
QTY
AMOUNT.,.
• PAID
PAID DATE
APPLIANCE REPAIR/ALTERATION
101-0000-42402
0
$12.09
$0.00
'PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY,
' IA;,DESCRIP.,TION� �
�; �� ACCOUNTx�� : � xi
�tQ
AMOUNT
�; PAID
�PAID:DATEF
APPLIANCE REPAIR/ALTERATION PC
101-0000-42600
0
$4.83
$0:00
�. PAID: BY z .,
4METHOD A$Y .art
a r
~RECEIPT #
_
: CHECK #
CLTD BYE
Total Paid forMECHANICAL• $16.92 $0.00
� g
ACCOUNT
- QTY"
AMOUNT
PAID DATEa
SMI - RESIDENTIAL'
101-0000-20308
0
$1.56
$0.00
iPAID BY
METHOD
�' ''RECEIPT #' $
- `CHECK
BYE*
Total Paid forSTRONG MOTION INSTRUMENTATION SMt $1.56 $0.00
TOTALS::000
r