BRES2017-0009LICENSED 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 Clas : C-8. C10. C29. C53, C27, D12 License No.: 656128
Date: / 2 3 /7 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 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: ^
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one ofthe 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.
/"9 1 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: STARSTONE NATIONAL INSURANCE COMPANY Policy Number:
- I certify that in the performance of tie 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 3P00 of the Labor Code, I shall forthwith
comply with t ose provisions. �.
Date: / Z 3 ! Applicant: / �� f /6°"l?Z
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 :N 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 applicacion 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 cancel[-ction.
I certify that I have read this application and sta-e 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 representat-ves of this city to enter upon the
above-mentioned property for inspection purpc5es.
Date: / 23 Signature (Applicant or Agent): -i g466,,
4 Qum&
VOICE (760) 777-7125
78-495 CALLE TAMPICO
FAX (760) 777-7011DESIGN
LA QUINTA, CALIFORNIA 92253
& DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 1/23/2017
Application Number:
BRES2017-0009
Owner: Z
Property Address:
80457 PLATINUM WY
d
TURNER RESTig
APN:
775220021
80457 PLATIN c
Application Description:
TURNER RESIDENCE / BBQ ELECTRICAL & WATER FEAT ELEC/WATE
LA QUINTA, C3 i
Property Zoning:
ti p�
Application Valuation:
$4,000.00
N Z
� C
Applicant:
Contractor: S O
a
TESERRA
TESERRA Z O W
Q I--:
P O BOX 1280
P O BOX 1280 p�.
COACHELLA, CA 92236
COACHELLA, CA 9?236
Z
(760)389-9 2� CD
Lic. No.: 6 W
---------------------------------------------------------------------------------------------
D
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 Clas : C-8. C10. C29. C53, C27, D12 License No.: 656128
Date: / 2 3 /7 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 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: ^
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one ofthe 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.
/"9 1 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: STARSTONE NATIONAL INSURANCE COMPANY Policy Number:
- I certify that in the performance of tie 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 3P00 of the Labor Code, I shall forthwith
comply with t ose provisions. �.
Date: / Z 3 ! Applicant: / �� f /6°"l?Z
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 :N 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 applicacion 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 cancel[-ction.
I certify that I have read this application and sta-e 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 representat-ves of this city to enter upon the
above-mentioned property for inspection purpc5es.
Date: / 23 Signature (Applicant or Agent): -i g466,,
Date: 1/23/2017
Application Number:
BRES2017-0009
Owner:
Property Address:
80457 PLATINUM WY
TURNER RESIDENCE
APN:
775220021
80457 PLATINUMJWY
Application Description:
TURNER RESIDENCE / BBQ ELECTRICAL & WATER FEAT ELEC/WATE
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
$4,000.00
Applicant:
Contractor:
TESERRA
TESERRA
P 0 BOX 1280
P O BOX 1280
COACHELLA, CA 92236
COACHELLA, CA 902236
(760)389-9222 1
-------------
---------------------------------------------------------------------------
Llc. No.: 656128
Detail: ELECTRICAL FOR BBQ, WATER AND ELECTRICAL FOR WATER FEATURE. PER 2016 CALIFORNIA BUILDING CODE
_c
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB 1473 FEE
101-0000-20306 0 $1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
Total Paid for ELECTF:ICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0
$96.27 .
Total Paid for PERMIT ISSUANCE: $96.27
DESCRIPTION
ACCOUNT
DTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
DTY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$12.67
Total Paid for PLUMBING FEES: $25.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - RESIDENTIAL
101-0000-20308
0
$0.52
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.52
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT -FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin # Gity Of La uin
//`` O Building 8r Safety Division
Permit # '060
0 V P.O. Box 1504, 78-495 Calle Tampico
n La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Track
_ N� in iz Sheet
Project Address: �3pa-j S-7 'Pl
Nu N LAJ
Owner's Name: —TU g N t— p -
A. P. Number:
TRACKING
Address:
Legal Description:
Contractor: S E$ IA
E-1�R
Plan Sets
City, ST, Zip: i 12Z5-3
> $ };•{s.;.: ;}+'f4 ^•++�{! r'0. ii
Telephone: '�Y„{.^:r�•''$::A/ ;� /{:i{.ij {�+:•
P
Address: Seo 0!) l-Vt Sy
Project Description:
City, ST, Zip: Ci1P� 1 z23L.
>,•?,<^"'1�<:{'k?R •-{vi �.
Telephone: Z!o d 3 22 Z.$ %.{ a; MINIM, ;
� 'r� w l� U
3
State Lic.
City Lie. #;
Arch., Engr., Designer.
L -F
Address:
Plan Chech Deposit
City., ST, Zip:
Truss Cales.
Telephone:
State Lic. #:
:R')' :ry+(• {.•Y ,}\.fNf•�!r
e>.� ; y�,,;.}{ ,'.+
{�:•,�.'i'i?�
I' $ w4 s {> {%;- y k
Construction Type: Occupancy:
Project type circle bne New Addfi Alter Repair Demo
Name of Contact Person: �j�� S Ef
�� Z
Sq. Ft.:
# Stories:
#Units:
Telephone #,of Contact P
2s0 - °j H I
Estimated Value of Project: -Y. �L,- 7vc>
N APPt ir_AMY- nn winr Inroor�
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Chech Deposit
Truss Cales.
Called Contact Person
Plan Checle Balance.
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2'd Review, ready for corrections/issue
Electrical _
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
30 Reyiew, ready for correctionstissue
Developer impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks: Appr
Date o_permit issue
Scho61 Fees
Total Permit Fees