BSPN2019-001178-495 CALLE TAMPICO 4 aCP Qu!K&
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: SPECIAL INSPECTION/
Application Number: BSPN2019-0011
Property Address: 78995 HIGHWAY 111 STE 2
APN: 643020051
Application Description: WASHINGTON 111 / IID ELECTRICAL RELEASE
Property Zoning:
Application Valuation:
Applicant: D
JOSE ABEL CUEN
POBOX 6341 JUN 2 7 2019
LA QUINTA, CA 92248
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 (commencing with Section 70001 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 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).:
(�� 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.).
.�O 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 R
Date: b ` 2q 1 Owner:
CONSTRUCTION LEN NG EN
I hereby affirm under penalty of perjury that there eanstr lion lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.),
Lender's Name:_
Lender's Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/27/2019
Owner:
WASHINGTON 111 LTD
30240 RANCHO VIEJO RD STE B
SAN JUAN CAPISTRANO, CA 92675
Contractor:
Llc. No.:
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 policy number are:
Carrier: Policy Number: _
i certify that in the performance of the work for which this permit Is issued, I
shal 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 hall forthwith
comply with those provisions.
Date: 6 — 22 — 3-0 (ek Applica
WARNING: FAILURE TO SECURE WORKERS'COMPEPYTION OVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ALTIFS ND 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 �e
above -mentioned property for inspection purposes. _
Date: G �� -20(al Signature (Applicant or Agent):
Date: 6/27/2019
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
Applicant:
JOSE ABEL CUEN
POBOX 6341
LA QUINTA, CA 92248
BSPN2019-0011
78995 HIGHWAY 111 STE 2
643020051
WASHINGTON 111 / IID ELECTRICAL RELEASE
Owner:
WASHINGTON 111 LTD
30240 RANCHO VIEJO RD STE B
SAN JUAN CAPISTRANO, CA 92675
Contractor:
;Llc. No.:
---------------------------------------------------------------------------------------------
Detail: THIS PERMIT IS FORA SPECIAL INSPECTION FOR AN IID RELEASE ONLY. IT DOES NOT INCLUDE ANI WORK TO ANY PART OF THE ELECTRICAL SYSTEM.
INSPECTOR TO VERIFY NO WORK HAS BEEN DONE.
DESCRIPTION I ACCOUNT I QTY I AMOUNT
SPECIAL INSPECTION 1101-0000-42404 10 $80.05
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION: $80.05
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
ta 0"tra
PERMIT #
PLAN LOCATION:
Project Address: 7�� (�- , f Z
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
Applicant Name: Jaw Nb-e� 6"ke
Address: M , X b 3w I
City, ST, Zip: 4 J/t (e, CA
Telephone: -? 60 6) 5- 2—
Email:
Iow ��-e�Cu-Q-n C 4 , COS
Valuation of Project $
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:
State Lic: City Bus Lic:
Property Owner's Name: ash (d7f, (/ ('
New Commercial / Tenant Improvements:
Address: 3 �-H0 tiJ � ���� �
Total Building SF
City, ST, Zip ►L :v co, rl �
Construction Type: Occupancy:
Telephone:9[
Email: N\,
CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
Submittal
Req'd
Ree'd
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
City Business License
WASHINGTON 111, LTD,
30240 RANCHO VIEJO ROAD, SUITE B
SAN JUAN CAPISTRANO, CA 92675
Telephone: (949) 443-1234
Facsimile (949) 443-1233
Email: jacktarr@iacktarrdc.com
June 27, 2019
City of La Quinta
78-495 Ca lie Tampico
La Quinta, CA 92253
Re: 78-995 Highway 111, Unit 2
La quinta, CA 92253
Dear Sirs:
Let this letter serve you as our written authorization to Mr. Jose Abel Cuen to represent Washington
111, Ltd, in obtaining the City Inspection of the above referenced premises for the installation of an
electrical meter.
Let us know should you need further information and if you have any questions please feel free to
contact my Associate Ms. Martha Inga at (949) 443-1234 extension 131.
Sincerely
Jack Tarr
Managing General Partner