BSPN2014-0032i
-
78 495 CALLE TAMPICO 44 Q" � D
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BSPN2014-0032
Property Address: 77865 AVENIDA MONTEZUMA
APN: 773074002
Application Description: ELECTRICAL RELEASE
Property Zoning:
Application Valuation:
[!:7 Applicant:
JACOBS AGENTOR /VERIZON 3161 MICHELSON DRVERIZON WIRELESS#500 IRVINE, CA 92612 MENT
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: /0 Zv/ Contractor:
OWNER ILET DF,f RATION
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) licensed pursuant to the Contractors'
State License Law.).
(_) I am exempt under Sec. . B.&P.C. for this reason
Date: O Owner:
CONST IOp DI GENCY
I hereby affirm under penalty of perjury th t 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 Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/14/2014
Owner:
COACHELLA VALLEY RECREATION
75841 CLINTON ST
INDIO, CA 92253
Contractor:
Llc. 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 I should become subject to the '
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: b I q11 Applicant:
WARNING: FAILURE TO SECURE WOR 'CO ENSA ON COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE
HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit issued
as a result of this application, the owner, and the applicant, each agrees to, and shall
defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is not
commenced within 180 days from date of issuance of such permit, or cessation of work
for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned.property for inspection purposes..
Date: �V y %� Signature (Applicant or Agent):
-.+-..li-D
FINANCIAL INFORMATION
�'.S.'.. ..il.. •�+'t - '�-i .+_. 1 J :_5:..$.._ 1� ...?JM.i.
1
Bin #
City of %a Quinto
Building &r Safety Division
M' ry P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
gS
Project Address: %`g S . V1.0 CJ
Owner's Name: Co ech C11u (/ti1�e— 124 �- 017
A. P. Number:v M caiazi,� A_
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Address: �Te2urM
%S� G C4l�C i% 0 h .
Legal Description: O f (3 v 1310 clk (?c
City, ST, Zip: L CiA . 2 2 S 3
Contractor: cbs � fb ( ie z8
Telephone: h ne: '
IM
Address: M 1 Ck CISon OQ `/2
-7
Project Description:
City, ST, Zip: ' l-VMeC i .Z 6/2
Structural Calcs.
Telephone:
::...
Reviewed, ready for corrections
State Lic. # AJA7
CityLic...#N
f�0 / . / ✓iil �/�-�.1 Tr✓i ' ho f
Arch., Engr., Designer:
�S rr
Address:
City., ST, Zip:
Telephone:
P
;;:>::>:;r:>i: ::.;.:.::•:
........ .............. .::::::::::::..:.
Construction Type: Occupancy:
State Lic.
Project type (circle one): New Add+ n Alter Repair Demo
Name of Contact Person: V C. w t / Li U
Sq. FL:
#Stories:
# Units:
Telephone #,of Contact Person: 7 99 3
Estimated Value of Project:
APPLICANT- DO NOT WRITF RFI OW THIS 1 INF
#
Submittal
Rcq'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance,
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
tad Review, ready for corrcctions/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Dccd
Plans picked up
S.M.T.
H.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
s`d Review, ready for eorrectionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
10
Description: ELECTRICAL RELEASE
Type: SPECIAL INSPECTION
Subtype: Status: SUBMITTED
Applied: 10/14/2014 PJU
Approved:
Parcel No: 773074002 Site Address: 77865 AVENIDA MONTEZUMA LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: Lot: 131
Issued:
NO 14
Lot Scl Ft: 0
Building Scl Ft: 0 Zoning:
Finaled:
Valuation: $0.00
Occupancy Type: Construction Type:
Expired:
No. Buildings -'o
No. Stories: 0 No. Unites: 0
Details: SPECIAL INSPECTION FOR ELECTRICAL RELEASE FOR IID PER AJ.
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