BELC2015-008778 495 CALLE TAMPICO .
T� Tit,, O.�i D A� Q"
� VOICE (760) 777-7125
FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT
- INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/14/2015
Application Number:
BELC2015-0087
Owner:
Property Address:
78611 HIGHWAY 111
ACM LA QUINTA IV -B
APN:
643220007
1800 AVE OF THE STARS 105
Application Description:
LA QUINTA SQUARE / IN -N -OUT / TEMPORARY POWER
LOS ANGELES, CA
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Property Zoning:
Application Valuation:
$2,500.000
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Applicant:
Contractor:
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S R BRAY LLC DBA POWER
1210 N RED GUM STREET
PLUS
S R BRAY LLC DBA POWER PL S '
1210 N RED GUM STREET 4
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ANAHEIM, CA 92806
ANAHEIM, CA 928016
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(714)507-1881
Llc. No.: 980589
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: B. C100, D31 License No.: 980589 �j
Date: q J Contractor: �IW`tl 1 "/
.�_,
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).:
(_J 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 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:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certificate cf consent to self -insure for workers'
io , as provided for by Section 3700 d the Labor Code, for the performance
of th w 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 perform:,nce 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 tha 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 37CO of the Labor Code, I shall forthwith
comply with those provisions.
Date: v / o —Applicant -
WARNING: FAILURE TO SECURE WORKERS'CWtIATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINA. 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 ACKNOWIEDGEMENT
IMPORTANT: Application is hereby made to the E uilding Official for a permit subject to
the conditions and restrictions set forth on this aoplication.
1. Each person upon whose behalf this applica-ion is made, each person at whose
request and for whose benefit work is performec 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 applicaton becomes null and void if work is
not commenced within 180 days from date of iss.iance of such permit, or cessation of
work for 180 days will subject permit to cancellafon.
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 ordina ices 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 -.T/1 / �� Signature (Applicant or Ag
FINANCIAL •R
`ACCOUNT ?"
•
QTY. '.: : -AMOUNT. -,;-,PAID PAID DATE
BSAS SB1473 FEE 101-0000-20306
0
$1.00 $0.00
^'" :•-PAID BY y J * METHOD , N �r
• RECEIPT # CHECK # CLTD.BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
}x?DESCRIPTION '' _ <
,. ACCOUNT' ;.
CITY'.
= AMOUNT • _
b PAID
PAID DATE
TEMP POWER SERVICE
101-0000-42403
0
$24.17
$0.00
1 .. PAID BY.. 4: „ p'
i' •METHOD -
RECEIPT .#
CHECK #
CLTD BY
r .: ,:._,DESCRIPTION . .. ,- . , r
-' 'ACCOUNT , ', ; ';..
QTY.
_ AMOUNT
PAID
PAID DATE'
TEMP POWER SERVICE PC
101-0000-42600
0
$16.92-/
$0.00
PAID BY r +'
METHOD _
RECEIPT #
CHECK #;,
' CLTD$Y
Total Paid for ELECTRICAL: $41.09 $0.00 1
.... DESCRIP,TIO.
;'ACCOUNT,;
'QTY,
--,'AMOUNT,:
'PAID :- , G� .
,PAID DATE
PERMIT ISSUANCE
101-0000-42404
0
$91.85
$0.00
V
METHOD "'
'RECEIPT #
CHECK #
CLTD BY
Total Paid for PERMIT ISSUANCE: $91.85 $0.00
TOTALS:•0
Description: LA QUINTA SQUARE / IN -N -OUT / TEMPORARY POWER
NAME
ADDRESS1
Type: ELECTRICAL
Subtype:
Status: UNDER REVIEW
Applied: 9/8/2015 SKH
Approved:
Parcel No: 643220007 Site Address: 78611 HIGHWAY 111LA QUINTA,CA 92253
Subdivision: PM 18418
Block: Lot: 1
S R BRAY LLC DBA POWER PLUS
Issued:
Lot Scl Ft: 0
Building Scl Ft: 0
Zoning:
Finaled:
Valuation: $2,500.00
Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0
No. Unites: 0
92806
Details: TEMPORARY POWER POLES. 2013 CALIFORNIA BUILDING CODES.
ADDITIONAL SITES
CHRONOLOGY
NAME TYPE
NAME
ADDRESS1
CITY.
STATE
ZIP
PHONE
FAX
EMAIL -
APPLICANT
S R BRAY LLC DBA POWER PLUS
1210 N RED GUM
STREET
ANAHEIM
CA
92806
(714)507-1881
CONTRACTOR
S R BRAY LLC DBA POWER PLUS
1210 N RED GUM
STREET
ANAHEIM
CA
92806
(714)507-1881
OWNER
ACM LA QUINTA IV -131800
AVE OF THE STARS
105
LOS ANGELES
CA -
--7(714)507-1881
FINANCIAL INFORMATION.
Printed: Monday, September 14, 2015 10:37:38 AM 1 of 2 C§?SYSTEMS
y DESCRIPTION
ACCOUNT
'QTY
''AMOUNT •
PAID
;PAID DATE
RECEIPT #
-
CHECK #
METHOD
PAID BY. ,' ,
CLTDf
BY e•
BSAS SB1473 FEE
101-0000-20306
0
$1.00
$0.00
F
Total Paid forBUILDING STANDARDS ADMINISTRATION $1.00 $0.00
BSA:
TEMP POWER SERVICE
101-0000-42403
0
$24.17
$0.00
TEMP POWER SERVICE
101-0000-42600
'0
$16.92
$0.00
PC
'
Total Paid for ELECTRICAL: $41.09 $0.00
PERMIT ISSUANCE
101-0000-42404
1 0
$91.85
$0.00
Total Paid forPERMIT ISSUANCE: $91.85 $0.00
TOTALS:00
REVIEWS
REVIEW TYPE` REVIEWER,' SENT DATE RETURNED. STATUS REMARKS
DUE DATE - NOTES
DATE
BOND INFORMATION
---w
Printed: Monday, September 14, 2015 10:37:38 AM 2 of 2 CR
SYSTEMS
llin # r ��
Permit #
'tC�2O(S'— r(
Project Address: l ��'
City of La Quinta
Building 8t Safety Division
78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Owner's Name: _ 4L�
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor:
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Telephone:
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Address: ix t0 N • Qed
CIA4) cST •
Project Description:
City, ST, Zip: Q WLA
Telephone:
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..........................:::::.::::::::::::::::::::::.
_ 0 CAT IN�
State Lic. #: 0(`05`61
City Lic.
Arch., Engr., Designer:
Address:
City., ST, Zip:
Telephone:
le one:
P
on truct Y
C s ton Type: Occupancy:
P
State Lic. #•
Project tYPa (circle one):: New Add'n _Ater Re P air Demo
Name of Contact Person:
jqtC4 A
Sq. Ft.:#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: 5 0
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
P RMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Bal: rice
Title 24 Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, ready for.correclions/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
I-I.O.A. Approval
Plans resubmitted
Grading
IN I10USE:-
'"! Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
EP a
Total Permit Fees
CITY OF LA, QEIpp j�ENT
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