BSPN2019-001078-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
AHAHMAD MANASRH
48970 EL ARCO
COACHELLA, CA 92236
T,lbt 4
QO
JUN 14 2019
DESIGN & DEVELOPMENT DEPAYMENT
BUILDING PERMIT
SPECIAL INSPECTION/
BSPN2019-0010
78742 HIGHWAY 111 STE B
643220016
MIKE'S SMOKE SHOP
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 Far 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 700m) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alfeged exemption, Any violation of Section 7031.5 by any appllcan t for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(M) 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 saie-
(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 hls a 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 wi11 have the burden of proving that
he pr 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: nk /f 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 Add
DIVOICE (760) 777-7125
FAX (760) 777-7011
P TIONS (760) 777-7153
CITY OF LA QUINTA
DESIGN & DEVELOPMENT DEPARTMENT Date: 6/14/2019
Owner:
P 4 LA QUINTA
78060 CALLE ESTADO
LA QUINTA, CA 92253
Contractor:
Llc. No.:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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' corn pensatlan insurance carrier and policy number are-
Carrier: _ Policy Number; _
0614 I certify that in the performance of the work for which this permit is issued, I
shall not employ any person 1n any manner so as to became 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.
Date: d r 8 Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN 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 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.
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 property for inspection purposes.
Date: -Y_� Signature (Applicant or Agent):
Date: 6/14/2019
Application Number: $SPN2019.0010
Property Address: 7$742 HIGHWAY 111:STt i
APN: 643220016
Application Description: MIKE'S SMOKE. SHOP
Property Zoning:
Application Valuation: -"; • . . ' ' ,�. Ir. i.
Applicant:
AHAHMAD MANASRH
48970 EL ARCO
COACHELLA, CA 92236
Owner:
P 4 LA QUINTA
78060 CALLE ESTADO
LA QUINTA, CA 92253
Contractor:
Llc. No.:
Detail: SPECIAL INSPECTION PER AJ FOR PROPOSED SMOKE SHOP. THIS PERMIT DOES NOT INCLUDE ANY WORK TO THE SUITE.
DESCRIPTION
ACCOUNT CITY I AMOUNT
SPECIAL INSPECTION 101-0000-42404 0 $80.05
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $80.05
za Qa�fra
(�AI fF0RNIA ---
Project Address
APN #:
Applicant Name:
Address:Ql��
City, ST, Zip: �{
Telephone: .
Email:
NEW
Contractor Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic: City Bus Lic:
Architect/Engineer Name:
Address:
City, St, Zip
Telephone:
Email:
State Lic: City Bus Lic:
Property Owner's Name:
Address:
City, ST, Zip
Telephone:
Email:
PERMIT # .6 5 v ZV � 00 ( D
RLAbJ LOCATION:
Project Description: J , r
- 1� ,'
Valuation of Project $
New SFD Construction:
Conditioned Space
Garage
Patio/Porch
Fire Sprinklers
Construction
Grading:
Bedrooms: I Stories:
SF
SF
SF
SF
Occupancy:
# Units:
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
# Submittal 1 Required
Plan Sets
Structural Calcs
Truss Calcs
Title 24 Calcs
Soils Report
Grading Plan (PM10)
Landscape Plan
Subcontractor List
Grant Deed
HOA Approval
School Fees
Burrtec Debris Plan
Planning approval
Public Works approval
Fire approval l
f
City Business License
Received