14-0237 (SPIN)P.O. BOX 1504
`78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: _ 14-00000_ 237_
Property Address. 78495 CALLE TAMPICO .LQ ARTS
APN: 770-130-001- - -
Application description: SPECIAL INSPECTION
Property Zoning: MAJOR COMMUNITY FACILITY
Application valuation: 0
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
1� INSPECTIONS (760).777-7153
Owner:
CITY OF LA QUINTA
78495 CALLE TAMPICO
LA QUINTA,.CA 92253
Date: 3/05/14
Contractor:
Applicant: Architect or Engineer: SOUTH VALLEY ELECTRIC
P.O. BOX 10067
PALM DESERT, CA 92255
(760)902-0827 ! e �y/
Lic. No.: 822972
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--------------------------------------------------------------------------------------- -- — --
LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION
I .hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: C10 , License No.: 822972 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
r issued.
Date: j -- C nv,�acto_l:_ _ 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
OWNER- UILDER DECLARATION • - insurance carrier and policy number are:
I hereby affirm under penalty. of perjury that I am exempt from the Contractor's State License Law for the Carrier HARTFORD FIRE Policy Number 57WEC3)I4201
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to_ 1 certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the .person in any manner so as to become subject to the workers' compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section
License. Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I hall o hwith r•omply,with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by �.,2 = if
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date_ �,7�J I 1/Applicant:
-(_ 1 1, asowner-of-the-property,-or my employees with wages'astheir sole compensation, will do the work, -and' - ` - - T
the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE=WORK RS' CUMPENSATICI COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).' - APPLICANT ACKNOWLEDGEMENT
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for
pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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
of La Ouinta, its officers, agents and employees for any actor 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 propert for pectio purposes.
<t Signature (Applicant or Agent):
LQPERMIT '
1
Application Number . . . . 14-00000237
Permit . . . SPECIAL INSPECTION
Additional desc .
Permit Fee . . . . 71.50 Plan Check Fee
.00
Issue Date . . . . Valuation
0
Expiration Date,_. 9/01/14 '
Qty Unit Charge Per
Extension
1.00 71.5000 EA MISC SPECIAL INSPECTION
71.50
- - - --------------------------------------
Special Notes and Comments
SPECIAL INSPECTION FOR LA QUINTA ARTS
FESTIVAL. THIS PERMIT INCLUDES ALL
TEMPORARY ELECTRIC REQUIRED.2013
CODES.APPROVED PER GB.
Fee summary Charged Paid Credited
Due
Permit Fee Total 71.50 .00 :00
71.50
PlanCheck Total •.00 .00 .00
.00 ,
Grand Total 71.50.. .00 .00
71.50
LQPERMIT '
1
Bin #
Qty of La Quinta
Building 8r Safety Division
P.O. Box 1504; 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contract —
�Ci �% �,
Telephone:
Address: ka ko)<,-Project
Description: .
City, ST, Zip: 1✓S
lJ-�
TeleP hone:
State Lic. # :
City Lic. #.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
P
Construction Type:Occupancy:
anc Occu :
State Lic. #:
Demo tYPa circle one): w Addn Alter
'Repair
Name of Contact Person:y-t�
'e
E
Sq. Ft.:
# Stories:
# Units:
Telephone #,of Contact Person:
Estimated Value of ProjecCr 0 Q -0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
.
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
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
L3
ot
tucv
PUBLIC WORKS DEPARTMENT
APPLICATION FOR PERMIT
13 0\a
Tract No: Project Name: VL4:5 e5
Vicinity: V k C_ C"�'tQ v Cam py S
Purpose of Construction (Le.: Rough Grading, Offsite Street, et .) I C\.
v bb l C. S-A e.
PescriN#ion of Construction (i.e.: See Plan Set No.. -Q1234) q * -tp tr. po rCX, ,ry
Dimension of Installation or Removal:
Approximate Construction Start Date: �� 5t a Q
Approximate. Construction Completion Date: 'NCR h j a a 13
Estimated Construction Cost: $ .
Estimated Construction Cost shall include the removal of all obstructions, materials, and debris, back -filling, compaction and
placing permanent resurfacing and or replacing improvements
Contact Name: \ 2 (1 0 ile. Phone Number: --(Db -- S(o y -�
Name of Applicant/Owner: j_�o_ u S o pat
Applicant Address: -7:1-(E5 1 5 p Com\ is m i C�
Applicant Telephone Number:. (o j - S (p _ 1 a' 14 x Q
Applicant E-mail Address: f{ a_�F \n l e -e
Name of Contractor:. (L - S
Contractor Address: po (2) 0u 1 Q 0 (D �- po.� rn �e 5 e c- C
Contractor Telephone
Contractor State License Number: C - Fe -se -D:
Contractor City Business License Number:
Contractor E-mail Address:
►A COPY OF THE CURRENT INSURANCE CERTIFICATE MUST BE PROVIDED -4
Applicant or Contractor General Liability Insurance Company:
Applicant or Contractor General Liability Insurance Policy Number:
Office Use Only:
Inspection Fee:
Permit Fee:
'As -Built,
Deposit: .
Dust. Control
Deposit:
Credit
Amount:
TOTAL FEE WE:
Applicati
Office Use Only:
Assigned Permit Number:
Approval Date:
Expiration
Date:
Issue
Date:
Administrative Authority:
X55