BSPN2016-001078-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BSPN2016-0010
79410 HIGHWAY 111
600390006
SPECIAL INSPECTION FOR UTILITY RELEASE
Applicant:
CESAR URENA - FOCUSED ON STUDENT SUCCESS
79410 HWY 111 STE 108
LA QUINTA, CA 92253
r EB U 12016
WYOFLAOUtNTA
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 — Contra
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.).
(_) 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
11111111111111111111
04
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:. 2/1/2016
Owner:
E&DD
2114 ARI LN
LOS ANGELES, CA 92253
Contractor:
Llc. No.:
• 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:
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-mentioned property for inspection purposes.
Date: _ �'� Signature (Applicant or Agent):
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT
:QTY.
AMOUNT.' '
PAID
PAID DATE
SPECIAL INSPECTION
101-0000-42404
0
$72.52
$72.52
2/1/16
PAID BY
" METHOD. ..
RECEIPT #,
::-CHECK #
CLTD BY
CESAR URENA - FOCUSED ON STUDE
DEBIT
R12477
590065
TSA
DESCRIPTION •
°ACCOUNT
QTY;
i.: AMOUNT
PAID
PAID DATE
SPECIAL INSPECTION PC
101-0000-42600
0
$181.29
$181.29
2/1/16
PAID BY
METHOD'`'
RECEIPT #
CHECK #
CLTD BY.
CESAR URENA - FOCUSED ON STUDE
DEBIT
R12477
590065
TSA
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
TOTALS:
$253.81
$253.81
Bin #
City of La Quinta
Building 8i Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #i
Project Address:
Owner'sName: r rG1'LGl �u e
A. P. Number:
Address: ®AW4111o
Legal Description:
City, ST, Zip: U 1
Contractor:
Telephone: ......
OM
Address:
Project Description: K) IY 4 1 �
City, ST, Zip:
Telephone:
It tzk
State Lic. # :
City Lic. #:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
aneY
Construction Type: Occupancy:
:
State �c#.
Repair Demo
(circle one): New A dd'n AlterRe
cttYPac
Name of Contact Person: ��,
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: 16Q -IS16 =90-3A
Estimated Value of Project: $ 2 joDS
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed.•
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
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
2nd 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 IIOUSE:-
1rd 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
;5
Permit Number: BSPN2O16-0010
Applied: 2/1/2016 Approved:
Issued: Finaled:
Status: UNDER REVIEW
Parent Permit:
Parent Project:
Details:
Description: SPECIAL. INSPECTION FOR UTILITY RELEASE
Site Address: 79410 HIGHWAY 111
City, State Zip Code: LA QUINTA, CA 92253
Applicant: CESAR URENA - FOCUSED ON STUDENT SUCCESS
Owner: E & DD
Contractor: <NONt3•'
SPECIAL INSPECTION FOR UTILITY RELEASE FOR SUITE 108,110 AND 111. THIS PERMIT DOES NOT PERMIT ANY WORK.
0
Printed: Monday, 01 February, 2016 1 of 1 OrL6! [w �/'
SYST[MS
Description: SPECIAL INSPECTION FOR UTILITY. RELEASE
Type: SPECIAL INSPECTION
Subtype: Status: UNDER REVIEW
Applied: 2/1/2016 TSA
Approved:
Parcel No: 600390006 Site Address: 79410 HIGHWAY 111 LA QUINTA,CA 92253
Subdivision: PM 31172
Block: 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 FOR UTILITY RELEASE FOR SUITE 108, 110 AND 111. THIS PERMIT DOES NOT PERMIT ANY WORK.
FINANCIAL
CONTACTS
NAME TYPE NAME
ADDRESSI
CITY
STATE ZIP PHONE FAX EMAIL
APPLICANT CESAR URENA - FOCUSED ON
STUDENT SUCCESS
79410 HWY 111 STE
108
LA QUINTA
CA 92253
OWNER E & DD
2114 ARI LN
LOS ANGELES CA 92253
FINANCIAL
INFORMATION
CLTD
DESCRIPTION ACCOUNT QTY ' AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY
BY
SPECIAL INSPECTION 101-0000-42464 0 $72.52
$72.52
2/1/16 R12477 590065 DEBIT CESAR URENA - TSA
FOCUSED ON STUDE
Printed: Monday, February 01, 2016 8:48:03 AM 1 of 2
SYSTEMS
DESCRIPTION ACCOUNT • CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD
BY
SPECIAL INSPECTION PC 101-0000-42600 0 $181.29 $181.29 2/1/16 R12477 590065 DEBIT CESAR URENA - TSA
FOCUSED ON STUDE
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: '$253.81 $253.81
PARENT PROJECTS
ATTACHMENTS
Printed:. Monday, February 01, 2016 8:48:03 AM 2 of 2
sysreMs