BSPN2017-004678-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype: SPECIAL INSPECTION/
c&t�t 4 4v QuIR&
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BSPN2017-0046
Property Address:
52170 AVENIDA CORTEZ
APN:
773202009
Application Description:
FLORES / UTILITY SPECIAL INSPECTION
Property Zoning:
Application Valuation:
Applicant:
SARA FLORES
LA QUINTA, 92253
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).:
(_) 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.).
(J 1, 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:
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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/18/2017
Owner:
SARA FLORES
LA QUINTA, 92253
Contractor: i-
�� OCT 182017
C17YOFLA QUINTA
6014=41UAgTY DEVEL OPMENITDEPARTP 9EtiT
Llc. No.:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one oc 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 =arrier and policy number are:
Carrier: _ Policy Number: _
I certify that in the performance of - he work for which this permit is issued, I
shall not employ any person in any manner soas 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 _700 of the Labor Code, I shall forthwith
comply with those provisions.
Date:
Applicant:
WARNING: FAILURE TO SECURE WORKERS' CC31APENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMIIIAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FO! IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNCWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on thi_ 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 -he 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 tie work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this appliotion 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 cancellatior-
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 enter upon the above-
mentioned pr perty or inspection purposes.
Da e: 7/ 17 Signature (Applicant or Agent):-%
Application Number: BSPN2017-0046
Property Address:. 52170 AVENIDA CORTEZ
APN: 773202009
Application Description: FLORES / UTILITY SPECIAL INSPECTION
Property Zoning:
Application Valuation:
Applicant:
SARA FLORES
LA QUINTA, 92253
Owner:
SARA FLORES
LA QUINTA, 92253
Contractor:
Date: 10/18/2017
Llc. No.:
--------------------------------------------------------------------------------------------
Detail: SPECIAL INSPECTION FOR IID RELEASE. THIS PERMIT IS NOT FOR WORK. 2016 CBC.
DESCRIPTION ACCOUNT
QTY AMOUNT
SPECIAL INSPECTION 101-0000-42404
0 $78.02
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $78.02
DESCRIPTION
ACCOUNT
I QTY
AMOUNT
Credit Card Fee
.101-0000-43505
0
$1.49
Total Paid for Credit Card Fee: $1.49
DESCRIPTION
ACCOUNT
FINANCIAL INFORMATION,
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
DESCRIPTION ACCOUNT
QTY AMOUNT
SPECIAL INSPECTION 101-0000-42404
0 $78.02
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $78.02
DESCRIPTION
ACCOUNT
I QTY
AMOUNT
Credit Card Fee
.101-0000-43505
0
$1.49
Total Paid for Credit Card Fee: $1.49
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin#
City .of La Quinta
Building & Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
r -
building Permit Application and Tracking Sleet
Permit#
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Project Addre
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C /tel' (f
-Owner's Nyne: _ I
A.P. Number
Address: /
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Legal Description:
City`'STJZip: / „ /�
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Contractor:
Telephone:
Address:P.roject.DescripYfon:
City, ST, Zip:
Telephone:
State Lie. #:
City Lie #:
Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lie. #:
Construction Type:
Proj. Type New Add'n
Occupancy:
Alter Repair Demo
Name of Contact:
SgFt:
#Stories
# Units:
Tele hone of Contact:
p 76 C) - 61S- 910
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING °
PERMIT FEES.
Plan Sets
Plan Check Submitted
Item
Amount
Structural Calcs
Reviewed, ready for corrections
Plan Chock Deposit:
Truss Calcs
Called Contact Person
Plan Check Balance:
Title 24 Calcs
Plans Picked Up
Construction:
Flood Plain Plan .
Plans Resubmitted
Mechancal:
Grading'Plan
2nd Rev, Ready for corrections /
Electrics:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading
IN-HOUSE
3rd 'Rev, Ready for corrections /
Developer Impact Fee
Planning Approval
Called Contact. Person'
A.I.P.P.
Pub. Wks. Apps
Date of permit issue
School Fees
Total Permit Fees