BPLB2016-014778-495 CALLE TAMPICO ' '
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LA QUINTA, CALIFORNIA.92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BPLB2016-0147
Property Address: 813357HUNDER GULCH WY
APN: 767790063
Application Description: BRADSHAW./ 70LF OF GAS LINE AND 6 FOOT TALL FIRE PLACE
Property Zoning:
Application Valuation: $10,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/3/2017
Owner:
IOTA GRIFFIN
4675 MACARTHUF CT NO
NEWPORT BEACH,. CA 0
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: C-8 C10 C29 C53 C27 D12 icense No.: 656128
�6ate: Contractor N
OWNER -BUILDER DEC ATION
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) licensedpursuant 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 COMPENSATI JN DECLARATION
I hereby affirm under penalty of perjury one of :he 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
ofk for which this permit is issued.
ve and will maintain workers' compensation insurance, as required by
�� 0I ha 00of the Labor Code, for the perforroance.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.
710160317
I certify that in the performance of t7ie 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 tha-., if I should become subject to the
workers'- compensation provisions of Section 3:00 of the Labor Codx I shall, forthwith
comply with t7/7
se provisions. ��
% ffAoolicant:t�i
WARNING: FAILURE TO SECURE WORKERS' COMPENS ON COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FORIIN 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 thisapplication.
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 owneq, 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 th_- 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 Lhave read this application and state that the above information is correct.
I agree to comply with all city and county ordirances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-,men`tiioone/d,p;perty for inspection purposes.
Date: " 3 / ! / Signature (Applicant x Agent n� °
s
Applicant:
Contractor:
TESERRA
TESERRA
P 0 BOX 1280
P 0 BOX 1280
COACHELLA, CA 92236
COACHELLA, CA 9.-236
(760)389-9222
Llc. No.: 656128
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: C-8 C10 C29 C53 C27 D12 icense No.: 656128
�6ate: Contractor N
OWNER -BUILDER DEC ATION
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) licensedpursuant 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 COMPENSATI JN DECLARATION
I hereby affirm under penalty of perjury one of :he 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
ofk for which this permit is issued.
ve and will maintain workers' compensation insurance, as required by
�� 0I ha 00of the Labor Code, for the perforroance.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.
710160317
I certify that in the performance of t7ie 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 tha-., if I should become subject to the
workers'- compensation provisions of Section 3:00 of the Labor Codx I shall, forthwith
comply with t7/7
se provisions. ��
% ffAoolicant:t�i
WARNING: FAILURE TO SECURE WORKERS' COMPENS ON COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FORIIN 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 thisapplication.
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 owneq, 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 th_- 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 Lhave read this application and state that the above information is correct.
I agree to comply with all city and county ordirances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the
above-,men`tiioone/d,p;perty for inspection purposes.
Date: " 3 / ! / Signature (Applicant x Agent n� °
!-DESCRIPTION
JINANCIAL INFORMATION
ACCOUNT =.TY
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
$96.27
Total Paid for PERMIT ISSUANCE:
$96.27
DESCRIPTION
ACCOUNT
D.TY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600
0
$25.33
Total Paid for PLUMBING FEES:
$38.00
Date: 1/3/2017
Application Number:
BPLB201670147
Owner:
Property Address:
81335 THUNDER GULCH WY
IOTA GRIFFIN
APN:
767790063
4675 MACARTHUF CT NO 1550
Application Description:
BRADSHAW / 701-F OF GAS LINE AND 6 FOOT TALL FIRE PLACE
NEWPORT BEACH,. CA 0
Property Zoning:
Application Valuation:
$10,000.00
Applicant:
Contractor:
TESERRA
TESERRA
P 0 BOX 1280
P 0 BOX 1280
COACHELLA, CA 92236
COACHELLA, CA 9:236 .
(760)389-9222
Llc. No.: 656128.
Detail: ENGINEERED 6 FOOT CMU FIRE PLACE AT REAR YARD [DOUGLAS FERRELL ENGINEERING).
2013 CALIFORNIA'BUILDING CODE.