BSPN2016-003278-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Tibt 4 4 Q"
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BSPN2016-0032
Property Address: 79430 HIGHWAY 111 STE 104
APN: 600390005
Application Description: SPECIAL INSPECTION FOR BUSIN
Property Zoning:
Application Valuation:
Applicant:
THERAPY FOR THE BODY
79430 HIGHWAY 111 STE 104
LA QUINTA, CA 92253
Q 0
ty W4)2D,
10
Owner:
DALIP TIBB
, 92253
D)Icontractor:
CITYOFLA RUINT_�
f DEVELOPMENTOEPART_M NTNT
LIC. 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, after, 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.).
(_J I am exempt under Sec. B.&P.C. for this reason
Date -Z3 - I L.Q Owner.,—
CONSTRUCTION
wner.—
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
iii
VOICE (760) 777-7125.
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/23/2016
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:.?' z3 LP Signature (Applicant or A
FINANCIAL .• !.
ACCOUNT QTY AMOUNT
PAID -PAID DATE
SPECIAL INSPECTION
101-0000-42404 0 $72.52
$72.52 3/23/16
PAID BY
METHOD 3' RECEIPT .#
CHECK # CLTD BY
PAMELA PETERSON
CHECK R14128
6237 MFA
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $72.52 $72.52
Description: SPECIAL INSPECTION FOR BUSINESS LICENSE
Type: SPECIAL INSPECTION
Subtype:
Status: ISSUED
Applied: 3/23/2016 MFA .
Approved: 3/23/2016 MFA
Parcel No: 600390005 Site Address: 79430 HIGHWAY 111 STE 104 LA QUINTA,CA 92253
Subdivision: PM 31172
Block:
Lot: 5
Issued: 3/23/2016 MFA
Lot Sq Ft: 0
Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $0.00
Occupancy Type:
Construction Type:
Expired: 9/19/2016 MFA
No. Buildings: 0
No. Stories: 0
No. Unites: 0
Details: SPECIAL INSPECTION FOR BUSINESS LICENSE
NAME TYPE NAME ADDRESS1 CITY . „ ,STATE Z1P PHONE FAX EMAIL,
APPLICANT THERAPY FOR THE BODY 79430 HIGHWAY 111 LA QUINTA CA 92253
STE 104
OWNER DALIP TIBB 92,253
Printed: Wednesday, March 23, 2016 11:41:24 AM 1 of 2
sysrrMs
INSPECTIONS
REVIEWS
REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS. REMARKS NOTES
DATE
Printed: Wednesday, March 23, 2016 11:41:24 AM 2 of 2
SYST[MS
BOND
INFORMATION
ATTACHMENTS
Printed: Wednesday, March 23, 2016 11:41:24 AM 2 of 2
SYST[MS
-4
Bin #
City of La Quint.a
Building &" Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address -Owner's I.
Nam
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: r: 0
Telephone:
Address:
Project Description:
City, ST, Zip:
1 o
�CL i ��(i ► ! ��
Telephone:
I
State Lie. # :
City Lie. #;
Arch., Engr., Designer:
Address: '
City., ST, Zip:
Telephone:
Construction TYPe- Occupancy:
State Lie. #:
Project tYPec (circle one): New Add'n Alter Repair r Dem o
Name of Contact Person iq yy��
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:GD3 _] Z) Z%
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Reed
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted"
Item
Amount"
Structural Cales.
Revic,,ved, 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 correctionslissue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN ROUSE:-
'q Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees,
Total Permit Fees