BSPN2018-003178-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
COLLEEN CORK
78450 HIGHWAY 111
LA QUINTA, CA 92253
D
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
SPECIAL INSPECTION/
BSPN2018-0031
78450 HIGHWAY 111 STE 2
604050043
THE CHIROPRACTOR STUDIO / SPECIAL INSPECTION
d
I hereby affirm
LICENSED CONTRACTOR'S DECLARATION
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CmaFiAI)1IN1A
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CDYDE►ELOP IENTQEPARfAIEiVr
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
ARIES INV INC
73301 FRED WARING DR 200
PALM DESERT, CA 92253
Contractor:
Llc. No.:
Date: 10/4/2018
un er penalty of perjury that I am licensed under provisions of Chapter 9 I hereby affirm under WORKEoR'SeCOMPENSATION DECLARATION
P y p IY one of the following declarations:
{commencing with Section 7000) of Division 3 of the Business and Professions Code, and
my License is in full force and effect. — I have and will maintain a certificate of consent to self insure for workers'
License Class: _ License No.: _ compensation, as provided for by Sect• 3
Date: Contractor
I hereby affirm under penalty of per By that
I DECLARATION
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 an,
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
Mjects 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
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 am exempt under Sec. BAP,
r [ ' r dSan It
Date: Owner: ~
1
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for I
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.), c
Lender's Name.
Lender's Address:
ion 1 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 La bar Cade, for the performance of the work for which this permit is
issued. My workers' compensation insurance carrier and policy number are:
Carr' • Polity Number: _
1 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 #hat, if I should become subject to the
workers' Compensation provisions of Sectio
comply with those provisions. 0 ° 1La6°r Code, ! shall forthwith
Date: �� — /
Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECTAN 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 EDGEMENT
IMPORTANT: Application is errebymade Ctonthh BuildingLOfficial 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
?mployees for any act or omission related to the work being performed under or
allowing issuance of this permit.
7. Any permit issued as a result of this application becomes null and void if work is not
ommenced within 180 days from date of issuance of such permit, or cessation of work
:)r 180 days will subject permit to cancellation.
certify that I have read this application and state that the above information is correct.
agree to comply with all city and county ordinances and state laws relating to building
instruction, and hereby authorize representatives of this
entioned property for inspection purposes. on the ab e-
tteI� Signature (Applicant or Agent):
Date: 10/4/2018
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
COLLEEN CORK
78450 HIGHWAY 111
LA QUINTA, CA 92253
BSPN2018-0031
78450 HIGHWAY 111 STE 2
604050043
THE CHIROPRACTOR STUDIO / SPECIAL INSPECTION
Owner:
ARIES INV INC
73301 FRED WARING DR 200
PALM DESERT, CA 92253
Contractor:
IMOMI]N
Detail: SPECIAL INSPECTION FOR THE CHIROPRACTOR STUDIO.•BUSINESS CHANGING FROM A REAL ESTATE OFFICE TO A CHIROPRACTOR OFFICE.
INSPECTOR TO VERIFY THAT NO CHANGES WERE MADE TO SUITE.
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT CITY
AMOUNT
SPECIAL INSPECTION
101-0000-42404 0
$78.02
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$78.02
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
TOTALS:
$5.00
PERMIT #
PLAN LOCATION:
Project Address:
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
Gv\
Applicant Name:
l
Address: .
City, ST, Zip:
Telephone:
Email:
,
Valuation of Project $
ii
Contractor Name:
New SFD Construction:
Address:
Conditioned Space
SF
City, St, Zip
Garage
SF
Telephone:
Patio/Porch
SF
Email:
Fire Sprinklers
SF
State Lic: City Bus Lic:
Arch/Eng Name: Construction Type: Occupancy:
Address: Grading:
City, St, Zip
Telephone: Bedrooms: Stories: # Units:
Email: 1
State Lic: City Bus Lic:
Property Owner's Name:
New Commercial / Tenant Improvements:
Address:
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone
Email:
78495 CALLE TAMPICO
LA QU I NTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittal
Req'd
Req'd
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM 10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval
City Business License