BSPN2016-003378-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
ADRIANA CABRERA
81875 AVE 48 #181
INDIO, CA 92201
T�r �& 1P 4"
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BSPN2016-0033
78370 HIGHWAY 111 STE 215
604050068
ADRIANA CABRERA /SPECIAL INSPECTION
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).:
(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 ) I am exempt under Sec. B.&P.C. for this reason
Date:
Owner:
54
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
POINT HAPPY REALTY
8665 WILSHIRE BLV STE 410
BEVERLY HILLS, CA 92253
LIC.
Date: 3/23/2016
Q
. r
h1�,Z 2 2�
CITY OF lA QUINTA
IMUNIT`( DEVELOPMENT DEPARTMENT ------------------------
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 polity 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
CONSTRUCTION LENDING AGENCY I agree to comply with all city and county ordinances and state la relating I
I hereby affirm under penalty of perjury that there is a construction lending agency for construction, and hereby authorize representatives of this city to t upon
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). above-mentioned proptrty for inspection purposes.
Lender's Name:
Lender's Address:
(Appi'can� nt o' r''�Agent):
Mi
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNTQTY
AMOUNT
PAID T
PAID DATE
SPECIAL INSPECTION
101-0000-42404
0 $72.52
,$72.52
3/23/16
PAID BY'
METHOD
RECEIPT #
CHECK # .
CLTD.BY `.
ADRIANA CABRERA
CHECK
R14140
101
RSE
DESCRIPTIONACCOUNT
QTY
AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION PC
101-0000-42600
0
$181.29
$0.00
PAID BY
METHOD'
RECEIPT # r
CHECK #
CLTD BY .
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $253.81 $72.52
TOTALS:
Description: ADRIANA CABRERA /SPECIAL INSPECTION
CONDITIONS
PAID
Type: SPECIAL INSPECTION
Subtype:
Status: UNDER REVIEW
Applied: 3/23/2016 RSE
Approved:
Parcel No: 604050068 Site Address: 78370 HIGHWAY 111 STE 215 LA QUINTA,CA 92253
Subdivision: PM 29736
Block:
Lot: 11
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:
FINANCIAL INFORMATION
CONDITIONS
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
NAME TYPE NAME ADDRESSI
CITY STATE ZIP PHONE FAX EMAIL
APPLICANT. ADRIANA CABRERA 81875 AVE 48 #181
INDIO CA 92201
OWNER POINT HAPPY REALTY 8665 WILSHIRE BLV STE
410
BEVERLY HILLS CA 92253
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
SPECIAL INSPECTION 101-0000-42404 .0 $72.52
$72.52
3/23/16 R14140 101 CHECK ADRIANA CABRERA RSE
SPECIAL INSPECTION PC 101-0000-42600 0. $181.29
$0.00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $253.81 $72,52
Printed: Wednesday, March 23, 2016 12:43:41 PM 1 of 2 (r7
SYSTEtitS
PARENT PROJECTS
Printed. Wednesday, March 23, 2016 12:43:41 PM 2 of 2 CR
SYSTEMS
�i
Iain #
Qty. of La Quinta
Building a Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
20) 6
Project Address. _
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wner's Name:
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rpt
A. P. Number:
J n ZZ 53
Address:
Legal Description:
City, ST, Zip: '
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Ga tar. _
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Pontr
Tele hone: -
Address:
Project Description:
City, ST, Zip:
CC p
Telephone: e h ne•
P
State Lic. # :
City Lie. #.:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:h
one
...............................................
ancY•
n Type: Occupancy:
Constructiontructi
State Lic. #:
Project type (circle a one • New Add'n Alter Repair air De mo
_
Name of Contact Person:
r
D t�
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: - D✓
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 Cales.
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
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. 1Vks. Appr
Date of permit issue
School Fees,
Total Permit Fees