14-0674 (SPIN)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE- TAMPICO FAX (760) 777-7011
LA.QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/21/14
Application Number: 14-00000674 Owner:
Property Address: 47050 WASHINGTON ST STE 4202. LA QUINTA DEVELOPERS
APN: 643-200-019- - - C/O WES OLIPHANT-
Application description: SPECIAL INSPECTION 77900 AVENUE OF THE STARS,
Property Zoning: COMMUNITY COMMERCIAL PALM DESERT,' CA 92211
Application valuation: 0 D
Contractor:!
Applicant: Architect or Engineer: Owner
MAY 2P 2, qI
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/jl/]� OF CITY -
Pot
FIkAkCE DEPT.co
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION _ • .
1hereby 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 thefollowingdeclarations: - • ,
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: License No.: for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
- .issued.
Date: Contractor.- _ 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 -BUILDER DECLARATION insurance carrier and policy number are:
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the ," Carrier - - - -. - - - - - - - - - - - - - - - - - -Policy Number = ':
• 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, I ,
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 shall forthwith comply with those provisions. -- -
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by - -
w pplicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Date: Applicant:
�. 1, 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 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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
�vX_,,� improve for the purpose of sale.). - APPLICANT ACKNOWLEDGEMENT
/a) 1, 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,
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 '
of La Quinta, its officers, agents and employees for any act or omission related to the work being
11 t� performed under or following issuance of this permit.
Dat 1 -1 Owner: _ 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
CONSTRUCTION LENDING AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the, I certify that I have read this application and state that the above information is correct. I agree to comply with all
work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county t enter upon the above-mentioned property for insRection purposes.
Lender's Name: �t
Dai: Signature or Age
Lender's Address:
LQPERMIT
„ Application Number . . ”. . . 14-00000674
Permit . . SPECIAL INSPECTION
Additional desc .
Permit Fee 71.50 Plan Check Fee
00
Issue Date . . . . Valuation . . .
0
Expiration Date 11/17/14
`
Qty Unit Charge Per
Extension
1.00 71:5000 EA MISC SPECIAL INSPECTION
71.50
Special Notes and Comments
SPECIAL INSPECTION TO ,RELEASE
ELECTRICAL. 2013 CALIFORNIA BUILDING
CODES.
Fee summary.' Charged Paid Credited
Due .
Permit Fee Total 71.50 .00 .00
71.50
r, Plan Check Total .00 .00, .00
.00
4 Grand Total 71.50 .00, :, :00,'
71.50'.
n
LQPERMIT'
.
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B'n #
City of La Quinta :
Building &r SafetyDivision
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
,•Project-Addre_l l / (-)5D W a5� i til � r" A. � t{aD
Name: 1 1 `(fie �- e
A. P. Number: C►q �i 9a�3Address:
'Owner's
l ('),5b
Legal Description:
rcity, ST, Zip: W &�A i YV• C k A C) aa5"J
Contractor:Telephone:
L�. LP �- L•i
:.,>.::s.:::::•.;;..;.�::::::..:
Address:y
4
rproject-Descriptio__n
City, ST, Zip:
l S
Telephone:
::<>:: a::t
State Lie. # : City Lie. M.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lie. #
Pro'ecta circle one): New Add'n Alter Repair typ ( ) p Demo
3Name of_Contact,Person:�� j� C,0 � Glle �
Sq. Ft.:
#Stories:
#Units:
xelephone # of Contact Eerson: W: 5D 1- �jo117 by,
Estimated Value of Project:
'7990 (1A20' 9(D9(D APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES.
Plan Sets
Plan Check submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Deposit
Truss Coles.
Called Contact Person
Plan Check Balance
Title 24 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2od 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:-
"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 Fees
Total Permit Fees
Alpine Mortgage Planning
Your Dreams. Otic Expertise,
To The City Of La Quinta
Please accept this letter authorizing Mercedes DeVoe 760-880-8364 or Bidi Gonzales 760-501-5217 or
Mike Chapa 760-399-7358 to order a city inspection as requiredby'IDD to turn on the power to 47-050
Washington Street, suite 4202, La Quinta, CA 92253
Thank You for your help
S ce �y tr
! Whltn D.aAn
Branch Manager
Direct 714-689-9824
Cell 949-322-3044
250 Commerce Suite 250 ,
Irvine, CA 92602
250 �....)Itic'+t 1 a's. `t i1e00" !v I C- CA 92602
P 714.689.9820 F 714.689.9876 www.atuinemc.com
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