BELC2019-0060May 23 19 02:33p
760-771-1910 p.1
78-495 CALLS TAM PICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype: ELECTRICAL/
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BELC2019-0060
Property Address: 79180 CORPORATE CENTRE DR STE 102
APN: 600390013
Application Description: PAUL 1110 UTILITY RELEASE
Property Zoning:
Application Valuation: $1.00
Applicant:
JAMES PAUL
79-180 CORPORATE CENTER STE N102 1 j— MAY 2- 3 2019
LA QUINTA, CA 92253
�' CITY OF LA QUINT'l
DESIGN & DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 fcommencing with Section 7000) of Division 3 of the Business and Professions Code,
and my' Icense is in full force and effect.
License Class: — License No.:
Date:
Contractor: _.--
OWNER-BUILDER DECLARATION
I herebyaffirm 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 countythat requires a permit to construct, alter, improve, demolish, or repair
arry 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) orthat he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Secticn 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more -,han flue hundred dollars
{
(_ s owner of the property, or my employees with wages as their sole
tar7t ensation, will do the warkr 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
wilth i n,q ne year of completion, the owner -builder w111 have the burden of proving tliat
kWhe did not bulld or improve for the ou►pose of sale.).
1, as owner of the property. ant exdusive;y contra: ting with licensed contractors
to ca struct the project. ISec_ 7044. ausiness 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 contractors) 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 perfofmance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address!—_
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 5/23/2019
Owner:
JAMES PAUL
79.180 CORPORATE CENTER STE i1102
LA QUINTA, CA 92253
Contractor:
Llc. Iva.:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a certificate of consent to self -Insure for workers'
compensation, as provided for by Section 37CO 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 pe,mit
is issued. My workers' compensation insurance carrier and pollcy number are:
Carri Policy Number:
ertify that in the performance of the work for which this permit is issued, I
shall n m play a fly 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 ofA a Labor C shaliforthwith
comply with those provisions.
Date: ApplicantC41 A -
WARNING: FAILURETO SECURE WORKERS' COrPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,0001. IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE;
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the BulldingOfflcial for a permit subject to
the conditions and restrlctlons 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 Quin ta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance ofthis permit.
2. Any permit issued as a result oFthis 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 relfnthe
ng
construction, and hereby authorize representatives of Ity nter
abova-me ntin nedproperty for inspection purpw
Date:' �alure(AppIicantorAgentl:
May 23 19 02:33p
760-771-1910 p.2
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT QTY
AMOUNT
3SAS SB1473 FEE
101-0000-20306 0
$1.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA:
$1.00
DESCRIPTION
ACCOUNT QTY
AMOUNT
ELECTRICAL- UTILITY RELEASE
101-000OA2400 0
$80.05
Total Paid for ELECTRICAL- UTILITY RELEASE:
$90.05
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE
101-0000-42416
0
$1D.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
Qaigra
�
- (:A1 iFOR Ni_. --
Project Address:'7 1 _�gz)
APN #: --tt /P,� �
Applicant Name: I
Add ress-
PERMIT IJCLC 2-019 — OOGO
Project Description:
City, ST, Zip:
Telephone:
Email: Valuation of Project
Contractor Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic: City Bus Lic:
Architect/Engineer Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic: City Bus Lic:
Property Owner's Name:
Address:
City, ST, Zip
Telephone:
Email:
New SFD Construction:
Conditioned Space
Garage
Patio/Porch
Fire Sprinklers
Construction
Grading:
Bedrooms: I Stories:
SF
SF
SF
SF
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
# Submittal Required I Received
Plan Sets
Structural Calcs
Truss Cale
Title 24 Calcs
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public :Works approval
Fire approval
City Business License