BSPN2016-002749
78-495 CALLE TAMPICO 4
T'� a� ` VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 3/7/2016 .
Application Number: BSPN2016-0027 Owner:
Property Address: 51555 -DESERT CLUB DR 200 KELLY DOMER DEV
APN: 770182001 999 ANDERSEN DR NO 160
Application Description: DC FUNDING / SPECIAL INSPECTION SAN RAFAEL, CA 92253
Property Zoning:
Application Valuation:
Applicant: Contractor:
PATTY JENAB
2016
LA QUINTA, CA 92253 MAR 0 7
Cly QF LA QUINTA
COMMUNITY DEVELOPMENT 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 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).:
( ) 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.).
(� 1, 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 contractors) 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
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, l 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 upon the
above -me do edpropertyfor inspection purposes.
Date:
/ r Signature (Applicant or Agent):'
v
FINANCIAL ••
•
DESCRIPTION
ACCOUNTHO
Y AMOUNT
PAID'
PAID DATE
SPECIAL INSPECTION
101-0000-42404
$71.50
$71.50
3/7/16
PAID BY
METHOD.
RECEIPT #
CHECK #
CLTD BY
AMERICAN PACIFIC MORTGAGE CORP
CHECK
R13604
346128
RSE
DESCRIPTION .
ACCOUNT
QTY
' AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION
101-0000-42404
0
$1.02
$1.02
3/7/16
PAID BY
METHOD '
RECEIPT #
CHECK #
CLTD BY
PATTY JENAB
CASH
R13606
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: DC FUNDING / SPECIAL INSPECTION
Type: SPECIAL INSPECTION Subtype: Status: UNDER REVIEW
Applied: 3/7/2016 RSE
Approved:
Parcel No: 770182001 Site Address: 51555 DESERT CLUB DR 200 LA QUINTA,CA 92253
Subdivision: DESERT CLUB TR UNIT 1 Block: 3 . Lot: 6
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 -NEW BUSINESS. THIS PERMIT IS NOT FOR WORK. 2013 CALIFORNIA BUILDING CODES
CONTACTS
NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL
APPLICANT PATTY JENAB LA QUINTA CA 92253
OWNER KELLY DOMER DEV 999 ANDERSEN DR NO SAN RAFAEL CA 92253
160
Printed: Monday, March 07, 2016 9:47:25 AM 1 of 2 C§?
SYSTGnAS
FINANCIAL••
•
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
CL BY
SPECIAL INSPECTION
101-0000-42404
0
$71.50
$71.50
3/7/16
R13604
346128
CHECK
AMERICAN PACIFIC
MORTGAGE CORP
RSE
SPECIAL INSPECTION
101-0000-42404
0
$1.02
$1.02
3/7/16
R13606
CASH
PATTY JENAB
RSE
Printed: Monday, March 07, 2016 9:47:25 AM 1 of 2 C§?
SYSTGnAS
DESCRIPTION ACCOUNT QTY AMOUNT• PAID, PAID DATE RECEIPT # CHECK # METHOD PAID BY, CLTD.
BY -
SPECIAL INSPECTION PC 101-0000-42600 0 $181.29 $0.00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $253.81 $72.52
BOND INFORMATION
Printed: Monday, March 07, 2016 9:47:25 AM 2 of 2
CN?WlysTems
Bin`#
City of La Q uin to
Building &r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and.Tracking Sheet
Permit #
Project Address: ✓ ��V rj �,�
Owner's Name:
A. P. Number:
Address:
Legal Description: �CA , rV ��
City,ST,Zip: CA &I
Contractor:
Telehone:
LisP
Address:
Project Description:
City, ST, Zip:
M0�'G�
ne•
TeleP ho .
State Lie. # :
City Lie. #;
Arch., Engr., Designer:
Address:
City, ST, Zip:
ele h ne:
Telephone:
P
anc
Construction Type: Occupancy:
s YP P Y•
S Lie. ie. #:
Project type (circle one • New Alter Repair Demo
Name of Contact Person: I
Sq. Ft.: _T9
Stories:
#Units:
Telephone # of Contact Person: y �() •3g�Q ' 0%
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
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
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Reyiew, 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