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BPLB2016-014778-495 CALLE TAMPICO ' ' �s 44vQ,wrw 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.