BURL2019-000178-495 CALLS TAMPICO D 4 Qa4a
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: ELECTRICAL - UTILITY (IID) RELEASE (WEB)/
Application Number: BURL2019-0001 /
Property Address: 78595 HIGHWAY 111 J �, /sd
lT�-
APN: 643220025
Application Description: SEIDEN-KAI J.C. / IID RELEASE
Property Zoning:
Application Valuation:
F /
Applicant: _>'rk j
TAMARA CANEDO
80760 AVERY DR
INDIO, CA 92201 �
CITY OF LAGIUINTA
CQ;`hhlhUNfTY DEVEI�VIvfEI'iT OEf?ARTf�1C,l f f
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.:
Date:
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
s2.Wects the applicant to a civil penalty of not more than five hundred dollars ($500).:
ZJL6Was owner of the property, or my employees with wages as their sole
Offimpensation, 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
t& did not build or Improve far the purpose of sale.).
as owner of the property, am exclusNei y contracting with licensed contractors to
tuns rust 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
awctors' State License Law.).
am exempt under Sec. B.&P.C. for this reason
Date:
CONSTRUCTION LENDIN 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 Na
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/2/2019
Owner:
JDD
78555 HIGHWAY 111
LA QUINTA, CA 92253
Contractor:
Lic. No.:
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
of the work for which this permit is issued.
I 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:_ 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 1 should become subject to the
workers' compensation provisions of Section 3700 of a Labor Code, I shall forthwith
comply lwith those provisions.
i]ate: 4l� OZ,— ; C _ Apphcaru:
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 ent on the above -
mentioned property for inspection purposes.
DaW: r,]1' U L' 1`7 75iMre (Applicant or Agent)
Date: 1/2/2019
Application Number: BURL2019-0001 Owner:
Property Address: 78595 HIGHWAY 111 JDD
APN: 643220025 78555 HIGHWAY 111
Application Description: SEIDEN-KAI J.C. / IID RELEASE LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
Applicant: Contractor:
TAMARA CANEDO
80760 AVERY DR
I N DIO, CA 92201
Llc. No.:
--------------------------------------------------------------------------------------------
Detail: IID RELEASE POWER OFF LONGER THAN 180 DAYS
f
FINANCIAL
DESCRIPTION
INFORMATION
ACCOUNT CITY
AMOUNT
ELECTRICAL - UTILITY RELEASE
101-0000-42400 0
$80.05
Total Paid for ELECTRICAL - UTILITY RELEASE:
$80.05
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
•
$5.00
•
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As
ress:
APN #:
Address:
City, ST, Zip:
Telephone: G
Email: ''T-' r
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lie:
Property Owner's Name:
Address:
City, ST, Zip
Telephone:
Email:
City Bus Lie:
MOR
PERMIT #
oc
PLAN LOCATION:
q Pro : Pool, Remodel, Add't, Elect, Plumb, Mech
Valuation of Project
Construction Type:
Grading:
Bedrooms: I Stories:
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000