12-0204 (SPIN)Z• - Cal
P.O. BOX 1504 ^� VOICE (760) 777-7012
78-495 CALLE TAMPICO 4
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/06/12
Application Number: 12_000002_04--' Owner:
Property Address: 78495 CALLE TAMPICO LQ ARTS CITY OF LA QUINTA
APN: 770-130-001 - - C/O AKLUFI & WYSOCKI
Application description: SPECIAL INSPECTION 3403 10TH ST STE 610
Property Zoning: MAJOR COMMUNITY FACILITY RIVERSIDE, CA 92501
Application valuation: 100
- Contractor:
Applicant: Architect or Engineer: SOUTH VALLEY. ELECTRIC ) 1
P.O. BOX 10067 a
PALM DESERT, CA 92255 C:I�W%r ;V:
(760) 902-0827
Lic. No.: 822972
LICENSED CONTRACTOR'S DECLARATION - -
L.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: C10 License No.: 822972
Contractor: _
OW ER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I amexempt 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-ampinyees with wages as their sole compensation, will dothe work, and
the. structure is not intended or offered for sale jSec. 7044, Business and Professions Code: The
Contractors' State License Law does riot 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 comple.tinn, 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.).
1 1" I am exempt under Sec. : 8.&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 wi11'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 TWIN CITY FIRE Policy Number. 57WECDI4201
_ I certify.that, in the performance of the work for which this permit is issued, 1 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 su 'ect to the workers' compensation provisions of Section
L3700 of the La or Code, I shall fort•th comply with those provisions.
plicant:
WARNING: FAILURE TO SECURE WORKERSOMPENSATION 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 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 Quima, 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 upo the above-mentioned property for spectjlbn purposes.
gnature (Applicant or Age ntl:
� T
Application Number . . . . . 12-00000204
Permit SPECIAL INSPECTION
Additional desc 2007 LA QUINTA ARTS FESTIVAL
Permit Fee 100.00 Plan Check
Fee
_ 00
Issue Date Valuation
. . .
. 0
Expiration Date . 9/02/12
Qty Unit Charge Per
Extension
BASE FEE
100.00
Special Notes and Comments
SPECIAL INSPECTION FOR LA QUINTA ARTS
FESTIVAL PER TUP #11-1086. THIS PERMIT
',INCLUDES ALL TEMPORARY ELECTRIC
REQUIRED. EVENT TO TAKE -PLACE
3/08/2012-03/11/2012.
Fee summary Charged Paid Credited
-----------
Due
----------
Permit, Fee Total 100.00 .00
---
.00
--
100..00
Plan Check Total .00 .00
.00
.00
Grand Total 100.00 .00
.00•
100.00
LQPE"11T
Bin #
Permit #
1 r-
Project Address: I
A. P. Number:
Legal Description:
Contractor: V �aTelephone:'`>'
0 E
Ow 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: L Q �� �v �.`Ic� ���to ►'1
Address: CAIIE�vj C
City, ST, Zip:
„ r ;: `s ":•
� � L ;c
Address: Q), 0. 000
Project Description:
City, ST, Zip: �S� ye CA / V E
Telephone:
t'' `, : ..'r::` ;�:•:_
State Lic. # :—
CityLic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone.
aj `_:'. s)u;:-: <•� �' :'�.-: %�s �.R. Construction Type: Occupancy:
'•
State Lic. #:
•'•
T ` pro ect type circle one New Add'n Alter Repair Demo
Name of Contact Person: JES - F PA—, .c Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person: p
I u -- O BY] j Estimated Value of Prnj e: t:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Rec'd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cales.
Reviewed, ready for corrections Plan Check Deposit
Truss Calcs.
Called Contact Person Plan Check Balance
Title 24 Cales.
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 corrections/issue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
�FESSho,
(App
F'
C,
75 jl SJr i,
I' r
AP ° E "
* /
REViEWEO EY •
ATE
Approval of theso p 'ns sha I not ."be
construied to be a p mit for, or an approval
of, any violation of any of the provisions
e; the state or local laws,. One set of
approved plans m be ept on the job
until completion.
,rt
c Wong Hobach Lau 1991