BSPN2014-003878-495 CALLE TAMPICO VOICE (760) 777-7125 � V
LA QUINTA, CALIFORNIA 9.2253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/26/2014
Application Number:
BSPN2014-0038
Owner:
Property Address:
78110 CALLE ESTADO
ROBERTS REAL ESTATE INV INC
APN:
770151004
P 0 BOX 1144
Application Description:
SPECIAL INSPECTION NEW BUSINESS
LA QUINTA, CA 92253
Property Zoning:
Application Valuation:
D a
Applicant:
Contractor:
TENANT:RAMIRO MENDOZA
77825 CALLE NOGALES
N 0 V 2 6 2014
LA QUINTA, CA 92253
CITY I
COMMUNITY DEVOE OLpA, DEPARTMENT
Llc. No.:
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 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 Divisio 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, 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 uilds or improves
thereon, and who contracts for the projects with a contractor( licensed pursuant to
the Contractors' State License Law.).
( I I am exempt under Sec. B.&P.C.A.this rea; n
Date:/ G Owner:
C STRUCTIO NDING AGENCY
I hereby affirm under penalty of perju 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
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 w�0-fo�^ hich this permit is issued,
shall not employ any person in any manner so as t6 becorr)E' subject to the workers'
compensation laws of California, and agree t if I shoul become subject to the
workers' compensation provisions of Sectj 37 0 of tJ�e Labor Code, I shall forthwith
comply with those provisions.
I Date: //1
WARNING: FAILURE TO SECURE WVEfiS' 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 abov rmation is correct.
I agree to comply with all city and county ordinances and st laws elating to building
construction, and hereby authorize representatives of this cit toe er upon the above
mentioned pro rty fo inspection purposes.
i
Date: ignature (Applicant or A
/ /x
FINANCIAL •R •
DESCRIPTION •+ .
pA00OUNT ; 'QTY
. ': ; AMOUNT?'. ',
PAID PAID DATE
SPECIAL INSPECTION
101-0000-42404 1
$72.52
$0.00
PAID BY..METHOD;
RECEIPT #
CHECK # CLTD BY
Total Paid forCOMPLIANCE SURVEY/SPECIAL INSPECTION:
TOTALS:•
$72.52
$0.00
0•
Description: SPECIAL INSPECTION NEW BUSINESS
Type: SPECIAL INSPECTION Subtype:
Status: SUBMITTED
Applied: 11/26/2014 PJU
Approved:
Parcel No: 770151004 Site Address: 78110 CALLE ESTADO LA QUINTA,CA 92253
Subdivision: DESERT CLUB TR UNIT 1 Block: 10
Lot: 9
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
Details: SPECIAL INSPECTION FOR NEW BUSINESS NO CHANGES TO BUILDING OR SPACE JUST MOVING IN.
Printed: Wednesday, November 26, 2014 12:01:30 PM 1 of 2
RW SYS 7EM5
0 -
Bin
City of La Quinta
Building &r 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
A. P. Number:
Address: / o
Legal Description:
City, ST, Zip: V-) +�, �4 a as3
c or: Q/%� l�
Telephone:
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Address: /
Projeet-Description:
City, ST, Zip: - �n47
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Telephone. — d (j
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State Lie. # :
City Lie. #t
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
.:
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Construction Type: Occupancy:
State Lie. #:w
Project type(circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone *,of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Rcq'd Rcc'd TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Cluck Deposit
Truss C2105.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
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.T.
II.O.A. Approval
Plans resubmitted
Grading
IN IiOUSE:-
'`' Revicw, ready for corrcctionsrissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees