BPLR2018-000678-495 CALLE TAMPICO D `� �� VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Date: 12/7/2018
POOL REMODEL (WEB)/PRIVATE Owner:
BPLR2018-0006 PAUL MILLER
79590 RANCHO SAN PASCUAL 11258 10A AVE NW
602280022 EDMONTON AB CANADA T6J, S3 92253
MILLER / GAS AND ELECTRIC FOR BBQ AND NEW POOL EQUIPMENT
Applicant:
STATEWIDE SERVICES INC DBA STATEWIDE CON
73-700 DINAH SHORE DR #405
PALM DESERT, CA 92211
D, Al �.
DEC 07 2018
09 t 41RAQUINP,
-Zmir113 er r':nA''T �FI!iT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: B License No.: 951607
U C� Corltrjp
OWNER -BUILDER DE ATION
I hereby affirm under penalty of perjury that I a xempt 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 Add
Contractor:
STATEWIDE SERVICES INC DBA STATEWIDE CON
73-700 DINAH SHORE DR #405
PALM DESERT, CA 92211
(760)699-5434
Llc. No.: 951607
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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.
have and will maintain workers' compensation insurance, as required by
Sect l n 3700 of the Labor.Cvde, for the performance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: BENCHMARK INSURANg.COMPANY Policy Number: CST5012063
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 thvSE pro islons.
--
WARNING: FAILURE TO SECURE WORKERS' 0ZENSATIO ERAGE IS UNLAWFUL,
4ND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
DNE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
ZOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
NTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
MPORTANT: Application is hereby made to the Building Official for a permit subject to
:he conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
equest and for whose benefit work is performed under or pursuant to any permit
ssued as a result of this application , the owner, and the applicant, each agrees to, and
;hall 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
ollowing issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
iot commenced within 180 days from date of issuance of such permit, or cessation of
vork for 180 days will subject permit to cancellation.
certify that I have read this application and state that the above information is correct.
agree to comply with all city and county ordinances and state laws relating to building
onstruction, and hereby authorize representatives of this city to enter upon the
hove mentio ed 7prperty for inspection purposes.
tj
It
mom e �(StI0up—lApplicant or Agent),
DESCRIPTION
DEVICES, FIRST 20
DESCRIPTION
DEVICES, FIRST 20 PC
DESCRIPTION
ACCOUNT
101-0000-42403
ACCOUNT
101-0000-42600
Total Paid for ELECTRICAL:
ACCOUNT
QTY
0
CITY
0
QTY
AMOUNT
$26.68
AMOUNT
$26.68
$53.36
AMOUNT
CONDENSER/COMPRESSOR
101-0000-42402 0
$40.02
DESCRIPTION
ACCOUNT CITY
AMOUNT
CONDENSER/COMPRESSOR PC
101-0000-42600 0
$26.68
Total Paid for MECHANICAL:
$66.70
DESCRIPTION
ACCOUNT QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS
101-0000-42401 0
$13.34
DESCRIPTION
ACCOUNT QTY
AMOUNT
GAS SYSTEM, 1-4 OUTLETS PC
101-0000-42600 0
$26.68
Total Paid for PLUMBING FEES:
$40.02
DESCRIPTION
ACCOUNT QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416 0
$10.00
Total Paid for RECORDS MANAGEMENT FEE:
$10.00
DESCRIPTION
ACCOUNT CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611 0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00
za �v
Project Address:
APN #:
A 1'
PERMIT # %)I Lr(L A 0
PLAN LOCATION:
Project Description: Pool, Remodel, Add% Elect, Plumb, Mech
WCA1-- kS l> T a Neil
PP scant Name. A( 1�VA!e., r 1 4- ?�fS .r,Fi ?AAt 40A
Address: < -
City, ST, Zip. P
Telephone: 40 9 "�5j3
Email: 7
ir1EYC5 v'cS4 4 4
Contractor Name: ! J
Address: Da
City, St, Zip 'D
Telephone: "7(0a„ �q -Sq3
Email: 1'G CWN , ,4je
State Lic: J �6 D City Bus Lic:
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email: w
State Lic: City Bus Lic:
Property Owner's Name:
Address: — 116C
City, ST, Zip
Telephone:
Email:
ter
Valuation of Project S ..3 O O
New SFD Construction:
Conditioned Space
Garage
Patio/Porch
Fire Sprinklers
Construction Type:
Grading:
Bedrooms: Stories:
€ SP f5all
SF
SF
SF
SF
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type:
R 22$ 3
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
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