BSPN2016-004878-495 CALLE TAMPICO
LA QUINYA, CALIFORNIA 92253
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BSPN2016-0048
Property Address:
47875 CALEO BAY STE 101
APN:
643200038
Application Description:
DENNIS PHAM /SPECIAL INSPECTION
Property Zoning:
Application Valuation:
Applicant:
DENNIS PHAM
47875 CALEAO BAY DR STE 101
IR 0,U] NTA, 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.
License Class: License No.:
Date:
Contractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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
I, as owner of the property, or my employees with wages as their sole
pensation, 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
she did not build or improve for the purpose of sale.).
I, as owner of the property, am exclusively contracting with licensed contractors Ror
struct 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
th ontractors' State License Law.).
( I am exempt under Sec. .B.&P.C. for this reason
Date:" Owner: 0 1.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance ofthe work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
C
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/23/2016 .
Owner:
CALEO BAY
P 0 BOX 13230
PALM DESERT, CA 92253
V�F3
7Z�l
Contractor.UN
U�C'i iY OF LA QUiNTA
00!AkiUN11Y DEVELOPMENT DEPARTMENT
Llc. 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.
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:- 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:
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 ($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 enter u o the
above-mentioned 9ro erty for inspection purposes,
Date: Signature (Applicant or Agent)
DESCRIPTION
FINANCIAL '
ACCOUNT
QTY , . AMOUNT .
PAID
PAID DATE
SPECIAL INSPECTION
101-0000-42404
0 $72.52
$72.52
6/23/16
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY.
DENNIS PHAM
DEBIT
R16526
RSE
DESCRIPTION -
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION PC
101-0000-42600
0
$181.29
$0.00
'PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $253.81 $72.52
Description: DENNIS PHAM / SPECIAL INSPECTION
Type: SPECIAL INSPECTION
Subtype:.
Status: UNDER REVIEW
Applied: 6/23/2016 RSE
Approved:
Parcel No: 643200038 Site Address: 47875 CALEO BAY STE 101 LA QUINTA,CA 92253
Subdivision: PM 31248
Block:
Lot: 2
Issued:
Lot Sq Ft: 0
Building Scl Ft: 0
Zoning:
Finaled:
Valuation: $0.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
Details: IID SPECIAL INSPECTION. THIS JOB CARD IS NOT FOR ANY WORK.
ADDITIONAL
CHRONOLOGY
CONDITIONS
CONTACTS
NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL
APPLICANT DENNIS PHAM 47875 CALEAO BAY DR LA QUINTA CA 92253
STE 101
OWNER CALEO BAY P O BOX 13230 PALM DESERT CA 92253
Printed: Thursday, June 23, 2016 2:00:48 PM 1 of 2 lsysrrnns
TOTALS: $253.81 $72.52 I
BOND INFORMATION
ATTACHMENTS
Printed: Thursday, June 23, 2016 2:00:48 PM 2 of 2
_ SYS TEti1S
4
Bin#
t)014 S
City of La Quinta
Building 81' Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
PN 20 )b-
Project Address:,
Aqc
i Owner's Name:
A. P. Number:
Address: 7!2 7Y Ca-Le4z,I
1
Legal Description:
City, ST Zip:
'Contra ct r
o.
�Cx.wt
Telephone:
Address:
Project Description: s C L
City; ST; Zip:
TeleP hone:
b
State Lie. # :
City Lie.
Arch., Engc., Designer:
Address:
City., ST, Zip:
Telephone:
Construction TY aneY
Pe: Occupancy:
:
State Lie. #
Project a circle one): New Add'n Alter Repair
J h'P �
Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person:
O .-
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
{!
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan
Plan Check submitted
Item
ount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Chec -.lance
Title 24 Cates.
ns picked upstruction
Flood plain plan
Plans rr su tted
Mechanical
Grading plan
2" Review, ready for c clions/is
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked
S.M.I.
II.O.A. Approval
PI resubmitted
Gr
IN I4OUSE:-
'^! Review, ready for corrections/issue
Developer Imp ee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School F
Total Permit Fees
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