BSPN2020-000978-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
DIANE HATZINGER RADLOFF
55837 CONGRESSIONAL
LA QUINTA, CA 92253
SPECIAL INSPECTION/
BSPN2020-0009
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DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
55837 CONGRESSIONAL
775241050
RADLOFF RESIDENCE / SPECIAL INSPECTION / BRES2017-0104
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
DIANE HATZINGER RADLOFF
55837 CONGRESSIONAL
LA QUINTA, CA 92253
P0 D Contractor:
MAR 12 2020 0
CITY OF LAQUINTA Llc. No.:
DESIGN & DEVELOPMENT DEPARTMENT
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: License No.:
Date: Contractor:
Date: 3/12/2020
WORKER'S COMPENSATION DECLARATION
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:
OWNER -BUILDER DECLARATION
Carr'
r Policy Number:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
!certify that In the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers'
city or county that requires a permit to construct, alter, improve, demolish, or repair any
compensation laws of California, and agree that, if I should become subject to the
structure, prior to its issuance, also requires the applicant for the permit to file a signed
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
statement that he or she is licensed pursuant to the provisions of the Contractor's State
comply with those provisions.
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
r2. 2 fJ2 '
and Professions Code) or that he or she is exempt therefrom and the basis for the
Date: Applicant:
all ed exempton. Any violation of Section 7031.5 by any applicant for a permit
is [he applicant to a civil penalty of not more than five hundred dollars {$500).:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
SUas owner of the property, or my employees with wages as their sole
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
"Insation, will do the work, and the structure is not intended or offered for sale.
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
apply to an owner of property who builds or improves thereon, and who does the work
INTEREST, AND ATTORNEY'S PEES.
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
APPLICANT ACKNOWLEDGEMENT
within one year of completion, the owner -builder will have the burden of proving that he
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
d not build or improve for the purpose of sale.),
the conditions and restrictions set forth on this application.
9he'lt
, s owner of the property, am exclusively contracting with licensed contractors to
1. Each person upon whose behalf this application is made, each person at whose
the project. (Sec. 7044, Business and Professions Code: The Contractors' State
request and for whose benefit work is performed under or pursuant to any permit issued
License Law does not apply to an owner of property who builds or improves thereon,
as a result of this application , the owner, and the applicant, each agrees to, and shall
and who contracts for the projects with a contractor(s) licensed pursuant to the
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
Contractors' State License Law.).
employees for any act or omission related to the work being performed under or
(_) I am exempt under Sec. B.&P.C. for this reason
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
Date: Owner:
for 180 days will subject permit to cancellation.
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
Lender's Address:
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 ilding
construction, and hereby authorize representatives of this city to enter upon e a ove-
mentioned property for inspection purposes.
eD
Date r -�- nature (Applicant or Agent)
Date: ?/12/21"'0
Application Number: BSPN2020-0009
Property Address: 55837 CONGRESSIONAL
APN: 775241050
Application Description: RADLOFF RESIDENCE / SPECIAL INSPECTION / BRES2017-0104
Property Zoning:
Application Valuation:
Applicant:
DIANE HATZINGER RADLOFF
55837 CONGRESSIONAL
LA QUINTA, CA 92253
Owner:
DIANE HATZINGER RADLOFF
55837 CONGRESSIONAL
LA QUINTA, CA 92253
Contractor:
Llc. No.:
Detail: SPEICAL INSPECTION FOR PERMIT BRES2017-0104 - INSPECTOR TO VERIFY THAT WORK WAS COMPLETED PER APPROVED PLANS FROM PERMIT
BRES2017-0104.
DESCRIPTION
FINANCIAL •• •
ACCOUNT CITY
AMOUNT
SPECIAL INSPECTION PC
101-0000-42600 0
$201.25
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$201.25
DESCRIPTION
ACCOUNT CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611 0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
$5.00