13-1079 (SPIN)4 P.O! BOX 1504 �VOICE 760 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/28/13
Application Number: 13-00001079 Owner:
Property Address: 79660 HIGHWAY 111 STE 104 DUNES BUSINESS PARK/ESF CAP.
APN: 649-020-014-4 -31143 - 3550 W. 6TH ST. #400
Application description: SPECIAL INSPECTION LOS ANGELES, CA 90020
Property Zoning: REGIONAL COMMERCIAL ---------------------------------
Application valuation: 0
Applicant:
Architect or Engineer:
--------------------------------------------------
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 Professionals 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 signedstatement 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
t t he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
a applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
( 1: 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 ISec. 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.).
fl 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.).
,d' I amexemptunder Sec. , B.&P.C. for this reason
Date: �+�� ~ )3 Own � I. v
C STRUCTION NDI AGEN ` r
I hereby affirm under penalty of perjury that there s a constructi len ' g agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
Contractor: r
U
Owner
Fi�"J J 2013
TY OF LA QUINTA
FINANCE DEPT,
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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:
C ier Policy Number
sl certify that, in the performance of the work for which this permit is issued, I shall not employ any,
i person in any manner so as to become subject to the workers' compensation laws bf California,
and agree that, if I should become subject to the workers' compensation provisions of Section
3700 of the Labor Cod , I shall forthwith comply with th a provisions. ` '
Dal. --418 13 App
lican tA.�)•CY� �tt'Ji.. � .
WARNING: FAILURE TO SECURE WOR ERS' COMPENS TIO OVERAGE S UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND 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. r
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety 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.
1 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 auth fir representatives
of this county to enter upon the above-mentioned propertyfVr inspection purposes.
oe
Date 0.g 13 Signature (Applicant or Agent. 11Z[I
Application Number . . . . . 13-00001079
Permit . . . SPECIAL -INSPECTION
Additional desc .
Permit Fee . . ... 71.50 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 2/24/14
Qty Unit Charge Per
Extension
1.00 71.5000 EA MISC SPECIAL INSPECTION,
-------------------------------------------------------- -------------------
71.50
Permit . . SPECIAL INSPECTION
Additional desc .
Permit Fee 178.75 Plan Check Fee
.00
Issue Date . . . . Valuation
0
Expiration Date 2/24/14
Qty Unit Charge Per
Extension
1.00 178.7500 EA MISC SPECIAL INSPECTION, PC
178.75
'
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Special Notes and Comments
INSPECTION FOR BUILDING OCCUPANCY ONLY
[DESERT DISCOUNT CLEANERS] THIS PERMIT
DOES NOT INCLUDE CONSTRUCTION, MEP
INSTALLATIONS OR BUILDING SIGNAGE..2010
CALIFORNIA BUILDING CODES.
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 250.25 .00 .00
250.25
Plan Check Total .00 .00 .00
.00
- Grand Total 250.25 .00 .00
250.25
LQPERMIT _
Bin #
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:q_ (� O W r t I I p �,4,
Owner's Name:
bb
A. P. Number: � VI ^ l.
jTp P ObS'7j
Address:
Legal Description:
Contractor.
City, ST, Zip:
Telephone:
Address:
Project Description:
City, ST, Zip:
Telephone:
State Lic. # : City Lic. #•:
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
one:
Construction Type: Occupancy:
aneY
State Lic. #:
.................................. A
Project type circle one): New Add'n Alter Repair Demo
Name of Contact Person: GWt*Q,0U M t . ,3AL&MM,4
Sq. Ft.:#Stories:
#Units:
Telephone # of Contact Person: 7 b 0 — d(.7 —,e ``I
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2od 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 HOUSE:-
'"' 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
42' L11
L
11
DESERT DISCOUNT
CLEANERS
79-660 Highway 1 1 1
Suite #104
LA QUINTA,
CA 90053