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14-0259 (SPIN)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/11/14 Application Number: 14-00000259 Owner: Property Address: 78965 HIGHWAY 111 WASHINGTON 111 LTD APN: 643-020-056- - - 80618 DECLARATION AVENUE Application description: SPECIAL INSPECTION INDIO, CA 92201 Property Zoning: REGIONAL COMMERCIAL Application valuation: 0 D d 1 Contractor: Applicant: Architect or Engineer: ERDMAN COMPANY r 1 ERDMAN PLACE MADISON, WI 53717 CITYOFI ,gQ (608)410-8000 0. !4, PINTA Lic . No.: 194614 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 Busines and Pro i als Code, and my License is in full force and effect. License Class: B license No.: 194 614 aU te: 3 i C tractor: ' 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 (5500).: (_ 1 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.). (_) 1, 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: LQPERMIT 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 tissued. 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 THE HARTFORD Policy Number 41WNQU1190 _ 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 to beco ub'ect to the workers' compensation laws of California, and agree that, if I shout -come the workers' compensation provisions of Section 3700 of the La r C d shall r comply with those provisions.. Applicant: 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 J$1 00,000). 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 Director of Building and Safety 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 thybuilding information ' orr I agree to comply with all city and county ordinances and state laws relating tostruction, authorize representatives of this -w ty enter upon theabove-mentioned prpectio e - DatSignature (Applicant or Agent): LQPERMIT Application Number . . . . . 14-00000259 Permit . . SPECIAL INSPECTION Additional desc . Permit Fee . . . . 71.50 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 19/07/14 Qty Unit Charge Per Extension 1.00 71.5000 EA MISC SPECIAL INSPECTION 71.50 ------------------------------------------------------------------=--------- Special Notes and Comments SPECIAL INSPECTION FOR ELECTRICAL RELEASE. 2013 BUILDING CODES. Fee summary Charged Paid Credited --------------------------------------------------------- Due Permit Fee Total 71.50 .00 .00 71.50 Plan Check Total .00 .00 .00 .00 Grand Total 71.50 .00 .00 71.50 t I Bin #f Permit # Z Project Address: 7D 6� '1Tl.✓ Qty of La Quinta Building a Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet �� Owner's Name: AIASA,. L a T� A. P. Number: Address: oa 0e_�AP_A �, m' Ail Legal Description: City, ST, Zip: Nit O Contractor: Z!EkVln 4M,0404 Telephone: :« `•r ' s :::>:<:>:r> :: ; ;.:<:> <: <: Address: t'�1 ��£ Project Description: ex /.$ City, ST, Zip: AM r SDN &1e 53717 /G L'r� t�,A4 e -i d -i1 Telephone: /,�,' 'L p ::is>> ;:.f•;;:•;:;:>;»;:: r•:>:>:•h State Lic. # : City Lie. #; Arch., Engr., Designer: Address: City., ST, Zip: Telephone: ?.::.>;;•.>s.,.. Construction Type: Occupancy: State Lic. #: aProJect tYP circle one): New Add, n Alter Repair Demo Name of Contact Person: 4o, -V 7 7- S 9 Sq. Ft.: # Stories: # Units: Telephone # of Contacf Person: H >C -� Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal " Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Cales. Called Contact Person Plan Check Balance. . Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''" Review, ready for corrcctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees