BSPN2015-002878-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
THOMPSON PROPERETY MANAG
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COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
BSPN2015-0028
79775 HIGHWAY 111103
600440005
SPECIAL INSPECTION TO RELEASE POWER
3151 AIRWAY AVENUE A-3
COSTA MESA, CA 92626
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).:
(_�U 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.).
(1 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: j 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
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 7/22/2015
Owner: '
KOMAR DESERT CENTER
10900 NUCKOIS ROADS
GLEN ALLEN, VA 23060
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: a 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•
mention/ed property for inspection purposes.
�� /Date: '�- Signature (Applicant or Agent):
Description: SPECIAL INSPECTION TO RELEASE POWER
ADDITIONAL
Type: SPECIAL INSPECTION
Subtype: Status: UNDER REVIEW
Applied: 7/22/2015 PJU
Approved:
Parcel No: 600440005 Site Address: 79775 HIGHWAY 111 103 LA QUINTA,CA 92253
Subdivision: PM 036269
Block: Lot: 5
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
3151 AIRWAY AVENUE
A-3
Details: SPECIAL INSPECTION TO RELEASE POWER TO OFFICE VACANT NO IMPROVEMENTS BEING DONE.
CA 92626 (804)790-7900
Printed: Wednesday, July 22, 2015 11:10:06 AM 1 of 2 C
SYSTEMS
ADDITIONAL
CHRONOLOGY
CONDITIONS
NAME TYPE NAME
ADDRESSI
CONTACTS
CITY
STATE ZIP PHONE FAX EMAIL
APPLICANT THOMPSON PROPERETY
MANAGEMENT
3151 AIRWAY AVENUE
A-3
COSTA MESA
CA 92626 (804)790-7900
OWNER KOMAR DESERT CENTER
10900 NUCKOIS ROADS
GLEN ALLEN
VA 23060 (804)790-7900
Printed: Wednesday, July 22, 2015 11:10:06 AM 1 of 2 C
SYSTEMS
Printed: Wednesday, July 22, 2015 11:10:06 AM 2 of I C
SYS7Eh15
Bin #
City of La Quinta
Bullding St: 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:1A 7S-
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Owner's Name: jnm
A. P. Number:
Address:
Legal Description.
City, ST, Zip:
Contractor:
Telephone:
Address:
Project Description:
City, ST, Zip:
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Telephone:
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State Lie. # :
City Lie. M.
Arelt., Dig., Ddigner:
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Address:
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City., ST, Zip:
Telephone:
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Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories:, # Units:
State Lie. #: :30IM
Name of Contact Person: VW /3/a17 n&17
Telephone # of Contact Person:
Q Zqoey
I Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
t/
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
_
Reviewed, ready for corrections
Plan Check Deposit
Truss Coles.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2n0 Review, ready for corrections/issue
Electrical
Subcontoctor List
Called Contact Person
Plumbing
Grant Decd
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
30 Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub, Wks. Appr
Date or permit Issue
School Fees
Total Permit Fees
®l Capital Square
®13 REALTY ADVISORS, LLC
July 21, 2015
City of La Quinta
78495 Calle Tampico
La Quinta, CA 92253
RE: 79775 Highway 111, La Quinta, CA 92253
To whom it may concern:
This letter authorizes Vel Blankenship or any representative of Thompson National Property
to pull permits on behalf of CSRA Komar Desert Center, DST.
This permit pull is to allow the City of La Quinta to inspect the property for purposes of
turning the power on to Suite # 103, located at the above referenced address.
I appreciate your assistance. '
Best regards,,
CSRA Komar Desert Center, DST
By: CSRA Komar Desert Center ST, LLC
By: IVliehael S: Waddell
Authorized Agent for Owner
10900 Nuckols Road, Suite 200 0 Glen Allen, Virginia 23060 0 804-290-7900