13-0708 (SPIN) Ste. 120P.O. BOX 1504 .
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application. Number: 13-00000708*
Property Address: 78134 CALLE TAMPICO STE 120
APN: 770-020-012- - -
Application description: SPECIAL INSPECTION
Property Zoning: VILLAGE COMMERCIAL
Application valuation: 700
T,it4t 4 4 " - -3
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
HIGHLAND LA QUINTA II LLC
80 S LAKE AVE STE 660
PASADENA, CA 91101
Applicant: Architect or Engineer:
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 Professionals Code, and my License is in full force and effect.
License Class: 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 or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
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' 1, as owner of the property, am exclusively contracting with licensed contractors toconstruct 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.). -
(_ 1 I am exempt under Sec. , BAP.C. for this reason
Date:
I
NSTRUCTION LENDH49-116FTiV ,_ .
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.).
61L.113
Lender's Name: _
Lender's Address:
LQPER.MIT
Contractor:
Owner
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/04/13
----JUN 84 2619
CITY OF LA QUINTA
FINANCE DEPT.
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
Cade, for the performance of the work for which this permit is issued. My workers' compensation
insurance carrier and policy numberare:
Carrier Policy Number
st 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'
I 3700 of the Labor Code, I hall orthw' omp 'th those provisions.
nate: 3 Applicant:
WARNING: FAILURE TO SECUR WORKER MPENSATI E IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI ALTIES 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 Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1. Each personuponwhose behalf this application is made, each person at whoserequest 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 county to enter upon the above-mentioned property for ' spe ' p oses.
Date: I Signature (Applicant or Agen
' t
Application Number 13-00000708
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Permit SPECIAL INSPECTION
Additional desc .
Permit Fee 250.25 Plan Check Fee'.
00
Issue Date . . . . Valuation
700
Expiration Date 12/01/13
Qty Unit Charge Per
Extension
1.00 71.5000 EA MISC SPECIAL INSPECTION
71.50
1.00 178.7500 EA . MISC SPECIAL INSPECTION, PC'
178.75
-----------------------------------------------------------------------------
Special Notes and Comments
INSPECTION FOR BUILDING OCCUPANCY
ONLY/VB/B-OCC/17-OL/SPRINKLED [DESERT
DISCOUNT CLEANERS] THIS PERMIT DOES NOT
INCLUDE CONSTRUCTION, MEP INSTALLATIONS
OR BUILDING SIGNAGE. 2010 CALIFORNIA
BUILDING CODES.
June 4, 2013.3:01:47 PM AORTEGA
Fee summary Charged Paid Credited
Due
Permit Fee Total 250.25 .00 .00
250.25
Plan Check Total .00 .00 .00
.00
Grand Total 250.25 .00 .00
250.25
7nl%
Bin #
erty Of L a Quinta
BuldIng at Safety Division
P.O. Box 1504,78-495 Calle Tampico
La' Quinta, CA 92253 --(760) 777-7012
Building Pennit -Application and Tracking Sheet
Permit #
13 • o'lc$
Project Address: '�$ i,3ii ��lCIez. #i`zc
0wner'sName:.LA�UiN77�, Y ''T 12L7u��T1 S
A.P.Number. �'TOC�;ZC>(� 3S -Z,
Addr=:yc CF'i`i�.IAiT 2<UCCR'CL�tVr T•?�%C
Legal Description:
Contractor.
Address:
City, ST, Zap: PM -M J)E�2,-,.T Gj
Telephone: 7 b 0 --3 4 5102
Project Description:
City, ST, Zip:
Telephone:
%AMML: ire
State Lia # : City Lie, 0,
Ar6 , Engr., Designer.
Address:
City, ST; Zip:
Telephone: Construction Type: Oaatpancy: $-=A.,
State Lia #: Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Sq. Ft : b �. , #Stories: l # Units
Telephone # of Contact Person: Est.Value of Project �•�–
APPLICANT: DO NOT WRITE BELOW THIS UNE
M
Submittal
Plan Sets
Req'd
Rec'd
TRACING PERMT FEES
Plan Check submitted Item Amount
Structural Calla.
Reviewed, ready for corrections Plan Check Deposit.
Truss CR1CS•
Called Contact Person Plan Check Balance
Title 24 Cates.
Plans picked up Construction '
Flood plain plan
Plans resubmitt.td Mechatiial
Grading plan
2•! Review, ready for corrections/issue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up SALL
H.O.A. Approval
Plans resubmitted Grading
IN ROUSE:-
''• Review, ready for corrections/issue. Developer Impact Fee
Planning Approval
Called Contact Person A X.P.
Pub. Wks. Appr
Date of permit Issue
School Fees
Total Permit Fees
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