BSPN2016-0042- 78-495 CALLE TAMPICO VOICE (760) 777-7125
_ C� O�i D .
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/27/2016
Application Number: BSPN2016-0042
Owner:
Property Address: 47875 CALEO BAY STE 104
CALEO BAY .
APN: 643200038
P 0 BOX. 13230
Application Description: BOHNET ACUPUNTURE AND CHIROPRACTIC / NEW BUSINESS
PALM DESERT, CA 92253
Property Zoning:
Application Valuation:
Applicant:
ContractTOMMI
KENNY47875
CALEO BAY STE 104
Fil
LA QUINTA, CA 92253
lc. No.:
LICENSED CONTRACTORS 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 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
($500).: ,
(-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.).
(_ ) I, 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
Lender's Address:
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 SUBIECT,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 upon the
aboo mentioned property for inspection purposes.
Date: OS - ? / ` Signature (Applicant or Agent): W11�(
Description: BOHNET ACUPUNTURE AND CHIROPRACTIC / NEW BUSINESS
Type: SPECIAL INSPECTION
Subtype: Status: UNDER REVIEW
Applied: 5/27/2016 SKH
Approved:
Parcel No: 643200038 Site Address: 47875 CALEO BAY STE 104 LA QUINTA,CA 92253
Subdivision: PM 31248
Block: Lot: 2
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $0.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
$72.52
Details: SPECIAL INSPECTION FOR NEW BUSINESS. THIS PERMIT IS NOT FOR WORK. 2016 CALIFORNIA BUILDING CODES.
ADDITIONAL
CHRONOLOGY
•NDITIONS
CONTACTS
NAME TYPE NAME ADDRESS1 CITY STATE ZIP PHONE FAX EMAIL
APPLICANT TOMMI KENNY 47875 CALEO BAY_ STE LA QUINTA CA 92253
104
OWNER CALEO BAY P 0 BOX 13230 PALM DESERT CA 92253
Printed: Friday, May 27, 2016 12:18:28 PM 1 of 2 CR
SYS TEti15
CLTD
DESCRIPTION ACCOUNT QTY
AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY
BY
SPECIAL INSPECTION 101-0000-42404 0.
$72.52
$0.00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$72.52
$0.00
TOTALS -00
Printed: Friday, May 27, 2016 12:18:28 PM 1 of 2 CR
SYS TEti15
INSPECTIONS
Printed: Friday, May 27, 2016 12:18:28 PM 2 of 2 CN?W.Iysrrms
Bin #
City of La QuInta
Buifding &T Safety Division
Permit # 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: 11>R�_5 /� LZu i Owner's Name: A
A. P. Number: ,4
16
Address: Cl celeoo
Legal Description:
City, ST, Zip:
Contractor: AA e t
Address:
//-4,,e/,;,r'
L /Telephone:__—
Project Description: CIO
xxx.,
. . . . . . . . . . .
City, ST, Zip:
Telephon-$2
.. . ........ . ....
State Lic. #
City Lic. #.-.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
....... ........
...........
Construction Type: Occupancy:
StateLic.
Project type (circle one): New Add' Alter
Repair Demo
Name of Contact Fers.n
Sq. Ft.:nes:
sto
Telephone # of Contact Person:
_7F#
Estimated Value of Project: e z
APPLICANT: DO NOT WRITE BELOW THIS LINE
9
Submittal
Reqld
Rec1d,
TRACKING'
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cale,
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance.
Title 24 CaIcs.
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
INHOUSE:-
3,d
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 FeO,
Total Permit Fees