BSPN2015-000878015 Main St Ste 106
BSPN2015-0008
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78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 922
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/10/2015
Application Number: BSPN2015-0008 Owner: is
Property Address: 78015 MAIN ST 106 BUILDING A L Q
APN: 770121007 6 ASHDOWN PL z
Application Description: OLD TOWN/NEWMAN/PEDEGO/SPECIAL INSPECTION TO OCCUPY HALF MOON BAY, CA 92253 m
Property Zoning: oT
Application Valuation: o
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Applicant: Contractor: D
BRYAN NEWMAN I
78015 MAIN STREET #106 M
LA QUINTA, CA 92253
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.
Licenss: 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 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 Address:
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.
A01111PI have and will maintain workers' compensation insurance, as required by
Secfio n 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: Appli
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 en er upon the above•
mentioned property for inspection purposes.
7vSignature
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Dates/ (Applicant or Ago
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/,
FINANCIAL INFORMATION
DESCRIPTION
ACCOUNT . QTY -,
;.AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION
101-0000-42404 1
$72.52
$0.00
•,PAID BY ;,.
r METHOD RECEIPT # f.
CHECK # CLTD BY
Total Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTION: $72.52 $0.00
TOTALS:• ••
Description: OLD TOWN/NEWMAN/PEDEGO/SPECIAL INSPECTION TO OCCUPY
Type: SPECIAL INSPECTION
Subtype:. Status: UNDER REVIEW
Applied: 3/10/2015 SKH
Approved:
Parcel No: 770121007 Site Address: 78015 MAIN ST 106 LA QUINTA,CA 92253
Subdivision: PM 30850
Block: Lot: 1
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $0.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
Details: SPECIAL INSPECTION FOR PEDEGO TO OCCUPY. THIS PERMIT 15 NOT FOR WORK. 2013 CALIFORNIA BUILDING CODES.
Printed: Tuesday, March 10, 2015 2:08:22 PM 1 of 2 CIZW YSTEMs
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES
DATE- DATE
FINAL"
PARENT PROJECTS
REVIEWS
REVIEW TYPE REVIEWER. SENT DATEDUE DATE RETURNED STATUS REMARKS NOTES,
DATE
d
Printed: Tuesday, March 10, 2015 2:08:22 PM 2 of 2 CL7[:1 WYSTfMS
BOND
INFORMATION
ATTACHMENTS
d
Printed: Tuesday, March 10, 2015 2:08:22 PM 2 of 2 CL7[:1 WYSTfMS
Bin #City
Permit #
Project Address: %So I
of La Quin to .
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
U Quinta, CA 92253 - (760) 777-7012
Building Permit'Application and Tracking -Sheet
rj, rt S f • Su .%' / p(o Owner's Name: 94
A. P. Number:
Address: 4ivl S% 2-,05
Legal Description:
City, ST, Zip: liC alttn7;!,
Contractor:. . .
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Telephone: lj( 6 00 % S
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Address:
Project Description:
City, ST, Zip:
Telephone:
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State Lic. #I :
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
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Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: . /
Net , r7.a h
Sq. Pt.: 652
# Stories:
# Units:
Telephone # of Contact Person:
`7 6.O -7,7 S — 20 S
Estimated Value of Project:
APPLICANT- DO NOT WRITE BELOW THIS LINE
#/
Submittal
Req'd
Recd
TRACKNG
PERMIT FEES.
Plaa Sets"
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit "
Truss Cala.,
Called Contact Person
Plan Check Balance.
Titic 24 Calcs.
Plans picked up
Construction '
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
tae Review; ready for corrections/issue .
Electrical
Subcontactor.List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A..Approval
. Plans resubmitted
Grading
IN ROUSE:-
'"' Review, ready for eorrcctionsfissui
Developer Impact Fee
Planning Approval
Called ContactTerson
Pub. Wks. Appr-
Date of permit issue
School Fees
Total Permit Fees