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BOTH2015-000578-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: BOTH2O15-0005 Property Address: 78611 HIGHWAY 111 APN: 643220007 Application Description: IN-N-OUT/SITE LIGHTING Property Zoning: Application Valuation: $20,000.00 Applicant: IN -N -OUT BURGERS 13502 HAMBURGER LANE BALDWIN PARK, CA 91706 Q�i �����}� ,6 T�/ V 4 �N�II�I�i(/ VOICE (760) 777-7125 vA FAX (760) 777-7011 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 10/20/2015 Owner: a OCT "00 2015 COMMUNITYI'l-Y OFO dOUIN EN OTAEPARTMENT 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: B License No.: 470763 (Date? IO'e�0 1S Contractorin- N-nufi �N«1Qr5 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 Name: Lender's Address Contractor: IN -N -OUT BURGERS ' 13502 HAMBURGER LANE BALDWIN PARK, CA 91706 (626)813-8274 Llc. No.: 470763 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 ��o70 Applic�t: n wr►c 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 ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above-mentioned property for inspection purposes. Date (0%010- 15Signatuie-('Applicant or Agent): aMINTOTALS �x 000 �$ s AMOUNTS PAID PAID DATE x �wncc�xi QTY A..,,,dI�IH:AA <...111 ."'K>.'-Z.T2....:4 BSAS SB1473 FEE 101-0000-20306 $1.00 $0.00 . .'.." - .3>'""..y a x BY x METHODS yy0 �`. -.l" hF.R;i t •'2-! h'K .'%4:+C:S ^S� S Y.. 4..(a RECEIP CHECK # �� CLTD BY 4� E,PAID C x z �${ � ��; Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: ' : $1.00 ` $0:00 .,,x..vxxu-in:':a`s'k.,,. syn '. ��'.�`���b'. r DESCRIPTION x.:. b E: AGCO.UNTriAM�OUNT v s g , � FAI" x F 'I s� � A DDATE� a;^e wt�".,�t:,a�� OTHER. ELECTRICAL EQUIPMENT. 101-0000-42403'., 0 '$24.47'.' $0.00 "i, >d.',�<�d�''E :e. �a PAIp BY� ��3 # `; c$•.s. �3+~. ,F;,. f = a METHOD pyx ">w"a .>."S..S...a\.S€ RECEIPTS#� Th:$°' ' C �x K#r C L�TDB To. s �p. _ .�.«�...< �,za ,>... ,:� �.T;�s ACHE rY.- DESCRIPTION y AC000NT W AMOUNT PAID -PAI6`4'# TE �:, > n: .•.r,. , E ,Ct N, Rn :,.�..k OTHER ELECTRICAL EQUIPMENT PC 0 $24:17•. ,$0.00 ce.Jb$:� ''iiY�. {101-0000-42600 . �>i'+.X4}kS{4 ->V `" rz i• #s per. i4 c :✓' - f Y<...K< ... `Y RECEIpT ,.-:4`x".u' .r�9 CHECK -' PAIDxBY. ;� `>....METHODs :4 #zµ, „ #..vR sGLTDBY Total Paid -for ELECTRICAL: $48.34 $0:00 :>Yx'K,_,, f4�i s r` ES if' y DESCRIPTION'' �y..H�Pe3} h'. 'E`tiyc,'•.Ay >"''`✓: 'a `h x ` %'<_ :.Y ACCOUNTQTY3� ?er (`�.s^14 -;'*fit' aff ,�[`. --eg2 ;, S- AMOUNT�� beef G E : . a* .'.$'. r RAID :. •, 7 PAID DAT E �. T .. ,.s,:. k a�rtus � > ;q s .. ,. ..: <e, ¢ a , . :. , -.. <.+'D6 �x *.s,, .w..w < $-d:*.nr.;.�N.,„fr�Y"�,',n:. > : .mom. ft—p ��i FLAG/LIGHTING POLE, .EA ADDITIONAL 101-0000-42404.. • 0 : .� $130.50 $0.00 . €F RAIDk BY �r E �E� Z `E`'itty: METHOD$€ E'.i [,:,W..'rviS>e.. Fi9x.5.� _Y £ RECEIPT# y. 'x.F CHECK # ::i37:-4rii�SY CLTD BYs e , k ZEN F i x DESCRIPTION p -;�x, t:` .s a: �, ACCOUNT,n TY r t AMOUNT P AID � a P AID DATE r ," -"...: . ......:... r .. , >r FLAG/LIGHTING POLE, EAADDITIONALPC 101-0000-42600 0 $39AS $0.00 E S . '..��::F L::D.•d 5 -iT PAID BY 3 T4:r-4*:Y Q,'l '�t•�`•Sl•S.. narA METHOD rLS'.'X.i 4> :�.a- #u.F-.x'%"'. p.. RECEIPT # II'. b$f':..w:.r'x 4 •F'f('iP vT CHECK # 'ki` _ .kT'' CLTD BY ,Y°F%�J ..:7z'i...3.....:....f .,��'s'.xeaeF:z�X,f,'s, ..�i s..c.,YW:_a's'<:.r.;�z� 3 �..r.Si`i'x',%1.. 39...: s, a� ^'fie,-> a` ]+i:T, 3£ b e p Vo -.4' .:.:. w �, Kl p �,6�.l€% M ?r; T taa Ge:`.w` ` --4-q r,DESCRIPTION , k kah,.,xirt•+..i�?. x. �-,. e.t:. .>t::•d, . f ,ACCOUNT a .9*• Es" xG? QTY ,£r'i r , AM,OUNT :. P+A.. 3<: >.'CD <�� < . .9 PAID DATE FLAG/LIGTHING.PssOLE,, FIRST 101-0000-42404. 0 $36.26-, $0.00 r -j F`2'�y: ... 'CA'gj £.p,LN.R`''j ° �% t. 'rb �:$!&' !?4 :>;,M'4...5. i METHOD RECEIRT #b s CHEEK # CLT,D �..s� �� a BY.. AMOUNTS PAI.DDAEACCO' ., FLAG/LIGTHING_ POLE, FIRST PC.. 101-000042600 0 $97.17 $0.00 f"4`Y-'` k �'.t"*�`a: $ f PAID BY �k'� a?h'„ >t.:;s ba. 4e�g s frk _ RECEIPT #�� .aG': ha» s-= +aC . t� zMETIiODu: ..W.CHEGK # fl �CLTDB Y� Total Paid for FLAG/LIGHTING POLE: $303.08 $0.00 aMINTOTALS �x 000 �$ s Permit Details PERMIT NUMBER T City of ,La Quinta BOTHp2DIS� 0005 Description: IN -N -OUT / SITE LIGHTING Type: STRUCTURE OTHER THAN Subtype: Status: APPROVED Applied: 10/7/2015 AOR BUILDING Approved: 10/14/2015 BHA Parcel No: 643220007 Site Address: 78611 HIGHWAY 111 LA QUINTA,CA 92253 Subdivision: PM 18418 Block: Lot: 1 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $20,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 No. Stories: 0 No. Unites: 0 Details: 10 LIGHT STANDARDS WITH ENGINEERED FOUNDATIONS PER APPROVED PLANS AND CALCULATIONS.2013 CODES. Applied to Approved Printed: Tuesday, October,20, 2015 10:09:19 AM 1 of 3 SYSTEMS ADDITIONAL CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE, NOTES NOTE KAY HENSEL 10/7/2015 10/7/2015 PER AJ - NEITHER STRUCTURAL NOR PLANNING REVIEWS REQUIRED. ALREADY APPROVED. PLAN CHECK SUBMITTAL AJ ORTEGA 10/7/2015 10/7/2015 PLAN CHECK SUBMITTAL RECEIVED VIA FEDEX, PROCESSED RECEIVED BY KAY AND MYSELF. emailed Katie sanchez that permit is approved & ready to TELEPHONE CALL BURT HANADA 10/14/2015 10/14/2015 issue. CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT IN -N -OUT BURGERS 13502 HAMBURGER BALDWIN PARK CA 91706 (626)813-8274 KSanchez@innout.com LANE Printed: Tuesday, October,20, 2015 10:09:19 AM 1 of 3 SYSTEMS FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY -AMOUNT> PAID CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX _ EMAIL CONTRACTOR IN -N -OUT BURGERS 13502 HAMBURGER BALDWIN PARK CA 91706 (626)813-8274 KSanchez@innout.com LANE EQUIPMENT OWNER IN -N -OUT BURGERS 13502 HAMBURGER BALDWIN PARK CA 91706 (626)813-8274 KSanchez@innout.com LANE OTHER ELECTRICAL 101-0000-42600 0 FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY -AMOUNT> PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTDBY BSAS SB1473 FEE 101-0000-20306 0 $1.00 $0.00 Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $0.00 BSA: OTHER ELECTRICAL 101-0000-42403 0 $24.17 $0.00 EQUIPMENT OTHER ELECTRICAL 101-0000-42600 0 $24.17 $0.00 EQUIPMENT PC Total Paid for ELECTRICAL: $48.34 $0.00 FLAG/LIGHTING POLE, 101-0000-42404 0 $130.50 $0.00 EA ADDITIONAL FLAG/LIGHTING POLE, 101-0000-42600 0 $39.15 $0.00 EA ADDITIONAL PC FLAG/LIGTHING POLE, 101-0000-42404 0 $36.26 $0.00 FIRST FLAG/LIGTHING POLE, 101-0000-42600 0 $97.17 $0.00 FIRST PC Total Paid for FLAG/LIGHTING POLE: $303.08 $0.00 TOTALS:00 Printed: Tuesday, October 20, 2015 10:09:19 AM 2 of 3 AWMAI GNITEYM SYSTEMS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS DATE NOTES 1ST BLDG NS (1 WK) BURT 10/7/2015 10/14/2015 10/14/2015 APPROVED HANADA BOND INFORMATION ATTACHMENTS Attachment Type CREATED OWNER DESCRIPTION PATHNAME SUBDIR ETRAKIT ENABLED DOC Invoice - APPROVED Invoice - APPROVED 10/14/2015 BURT HANADA SITE LIGHTING.pdf SITE LIGHTING.pdf 1 Printed: Tuesday, October 20, 2015 10:09:19 AM 3 of 3.