BELC2019-002478-495 CALLE TAMPICO Tih/ D eldfv Qm,1k&
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: ELECTRICAL/
Application Number: BELC2019-0024
Property Address: 78495 CALLE TAMPICO
APN: 770130001
Application Description: CITY HALL LOBBY / LOBBY RECEPTACLES
Property Zoning:
Application Valuation:
Applicant:
a
CITY OF LA QUINTA DD
78495 CALLE TAMPICO MAR 01 2019
LA QUINTA, CA 92253
CITY OF LA QUINTA
DESIGN & DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 fcommencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: C10. C46. License No.: 481 2 1
i
Date: 9Contracto'r:�l�+��
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).:
(_) 1, 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, 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
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/20/2019
Owner:
CITY OF LA QUINTA
78495 CALLE TAMPICO
LA QUINTA, CA 92253
Contractor:
VINTAGE E & S INC
49950 JEFFERSON STREET 130-388
INDIO, CA 92201
(760)775-0135
Llc. No.: 481352
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 ttjtvotk for which this permit is issued.
9z�- ! 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: HARTF RD ACCIDENT AND INDEMNITY COMPANY ACCIDENT AND INDEMNITY COMPANY 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.
Dater Applichnt:
WARNING: FAILURE TO SECURE WORKERS' CO EN TICIN COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NALTIES 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 ATTORNEYS 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.
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
:onstruction, and hereby authorize representatives of this city to enter upon the
above -mentioned propep for inspection purposes.
)ate: 1^ 1� Signature (Applicant or Agent : aV-
Date: 2/20/2019
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
CITY OF LA QUINTA
78495 CALLE TAMPICO
LA QUINTA, CA 92253
BELC2019-0024
78495 CALLE TAMPICO
770130001
CITY HALL LOBBY / LOBBY RECEPTACLES
Detail: INSTALLATION OF (3) RECEPTACLES ON THE NORTHWEST WALL IN THE CITY HALL LOBBY.
Owner:
CITY OF LA QUINTA
78495 CALLE TAMPICO
LA QUINTA, CA 92253
Contractor:
VINTAGE E & S INC
49950 JEFFERSON STREET 130-388
INDIO, CA 92201
(760)775-0135
Llc. No.: 481352
FINANCIAL INFORMATION
Existing Power
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City of La Quinta - Lobby
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DESIGN AND DEVELOPMENT
DEPARTMENT
W (760)777-7125
-u%s4o,l*uua - INSPECTION RE �
(760)777-7153 ��
Owner CITY OF LA QUINTA Cn w
Contractor VINTAGE E & S INC U
Number BELC2019-0024 0Permit
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POST ON JOB IN A CONS I OUS�A[5 w
INSPECTOR MUST SIGN ALL AP AB SP�
JOB ADDRESS 78495 CALLS TAMPIC
NOTES INSTALLATION OF 3 RECE ACMS N THE
2S2-
NORTHWEST WALL IN THE CITY HALL L o
MASONRY INSPECTIONS
FOOTINGS I STEEL
BOND BEAM
ABOVE APPROVALS DO NOT INCLUDE THE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING