BSPN2017-0034V
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78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number: BSPN2017-0034
Property Address: 79410 HIGHWAY 111 STE 109
APN: 600390006
Application Description: CABALLERO /SPECIAL INSPECTION FOR IID RELEASE
Property Zoning:
Application Valuation: .
Applicant:
1ULIETA MARTINEZ DE CABALLERO
79410 HIGHWAY 111
LA QUINTA; CA 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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date:. 7/25/2017
Owner:
Carrier: _ Policy Number: _
E&DO
I certify that in the performance of the work for which this permit is issued, I
2114 ARI LN
shall not employ any person in any manner so as to become subject to the workers'
LOS ANGELES, CA 92253
compensation laws of California, and agree that, if I should become subject to the
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workers' compensation provisions of Section 3700.of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions.
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3 of the Business and Professions Code) or that he or she is exempt therefrom and the
Contractor:
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WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
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AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
�) I, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
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Llc. No.:
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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 polity number are:
OWNER -BUILDER DECLARATION
Carrier: _ Policy Number: _
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
I certify that in the performance of the work for which this permit is issued, I
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
shall not employ any person in any manner so as to become subject to the workers'
.city or county that requires a permit to construct, alter, improve, demolish, or repair
compensation laws of California, and agree that, if I should become subject to the
any structure, prior to its issuance, also requires the applicant for the permit to file a
workers' compensation provisions of Section 3700.of the Labor Code, I shall forthwith
signed statement that he or she is licensed pursuant to the provisions of the
comply with those provisions.
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
Date: Applicant:
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
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
($500).:
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
�) I, as owner of the property, or my employees with wages as their sole
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
compensation, will do the work, and the structure is not intended or offered for sale.
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
(Sec. 7044, Business and Professions Code: The Contractors' State License Law does not
INTEREST, AND ATTORNEY'S FEES.
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
APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that
the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.)..
1. Each person upon whose behalf this application is made, each person at whose
(_) I, as owner of the property, am exclusively contracting with licensed contractors
request and for whose benefit work is performed under or pursuant to any permit
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
employees for any act or omission related to the work being performed under or
the Contractors' State License Law.).
following issuance of this permit.
(_) I am exempt under. Sec. B.&P.C. for this reason
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.
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
Lender's Add
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 �rop7erty for inspection purposes.
Date: 2S Signature (Applicant or Agent):
Date: 7/25/2017
Application-Number: BSPN2017-0034
Owner:
Property Address: 79410 HIGHWAY 111 STE 109
E & DD
APN: 600390006
2114 ARI LN
Application Description: CABALLERO /SPECIAL INSPECTION FOR IID RELEASE
LOS ANGELES, CA 92253
Property Zoning:
Application Valuation:
Applicant:
Contractor:
JULIETA MARTINEZ DE CABALLERO
79410 HIGHWAY 111
LA QUINTA, CA 92253
Llc. No.:
l5etail: SPECIAL INSPECTION FOR IID RELEASE. THIS PERMIT IS NOT FOR WORK. 2016 CALIFORNIA BUILDING CODES.
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FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
SPECIAL INSPECTION 101-0000-42404 0 $76.00
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: ' $76.00
TOTALS:00
13
Bin #
city 'f LQ Quinta
Building &r Safety Division
78-495 Calle Tampico
La Quinta, CA 92253.- (760) 777-7012
Permit Application and Tracking Sheet
Permit #
T25Y1JZA—_0Qe24_Building
Project Address: ��Q (
Owner's Name:
A. P. Number: �� ' h
Address:
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Legal Description:
City, ST, Zip: S CA •
Contractor:
Te le P hone
Address:
Project Description:
City, ST, Zip:
920
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Telephone:
State Lic. # :
City Lic. #.-.
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
1 one -
State Lic. #: •;>:>:;•s,::: ............:...
Name of Contact Person: V `� Aa D
Con structi on T YPe• Occupancy:
Project ct tYPa circle one): New Add'n Alter Repair Demo
Sq. Ft:
# Stories:
#Units:
Telephone # of Contact Person: o (p
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 talcs
Reviewed, ready for corrections
Plan Check Deposit
Truss talcs.
Called Contact Person
Plan Check Balance
Title 24 talcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2w° Review, ready for correctionstissue
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 corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees