BCOM2019-004878-49i CALLE TAMPICO D `�� VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 9/3/2019
Permit Type/Subtype: BUILDING COMMERCIAL/REMODEL Owner:
Application Number: BCOM2019-0048 CITY OF LA QUINTA
Property Address: 78495 CALLE TAMPICO 78495 CALLE TAMPICO
APN: 770130001 LA QUINTA, CA 92253
Application Description: CITY OF LA QUINTA / REMODEL ROOM AT NORTH EAST CORNER
Property Zoning:
Application Valuation: $4,000.00
Applicant: Contractor:
CITY OF LA QUINTA - KRIS GUTERSON P
CITY OF LA QUINTA - ALFRED BERUMEN
78495 CALLE TAMPICO SEP 0 3 2019 78495 CALLE TAMPICO
LA QUINTA, CA 92253 LA QUINTA, CA 92253
CITY OF LA(�UINTA (760)777-7000
DEIGN & DEVELOPNIENT DEPARTMENT Llc. No.::AZA:1506030156221903
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
al leggo exemption. Any violation of Section 7031.5 by any applicant for a permit
2!51��
he applicant to a civil penalty of not more than Five hundred dollars (5500).:
owner of the property, or my employees with wages as their sole
tion, 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 hers through his or her own employees, provided that the improvements
are not int ed or offered for sale. If, however, the building or improvement is sold
within a year of completion, the owner -builder will have the burden of proving that he
or she d not build or improve for the purpose of sale.).
as owner of the property, am exclusively contracting with licensed contractors to
c try the project. (Sec. 7044, Business and Professions Code: The Contractors' State
L' e w 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. f9r this reason
Da
Owner:
CONSTRUCTION LENDING AOUNCY
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 Na
Lender's Address:
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 w kers' compensation insurance carrier and policy number are:
Ca Policy Number:
1 certify that in the performance of the work for which this permit is issued, I
shal no ,ploy 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' a mpen d n provisions of Section 37. of the Labor Code, I shall forthwith
complyvytitft thaseprovis[ons.
Date: - 1 1 C] l k f 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 ofthis 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.
agree to comply with all city and county ordinances and state laws relating to building
construc on, a d hereby authorize representatives of thi y to �er upon the above-
mentiane pro erty f r inspection purposes.
Date: Signature (Applicant or Ag OnA,
Date: 9/4/2019
Application Number:
BCOM2019-0048
Property Address:
78495 CALLE TAMPICO
APN:
770130001
Application Description.
CITY OF LA QUINTA / REMODEL ROOM AT NORTH EAST CORNER
Property Zoning:
Application Valuation:
$4,000.00
Applicant:
CITY OF LA QUINTA - KRIS
GUTERSON
78495 CALLE TAMPICO
LA QUINTA, CA 92253
Owner:
CITY OF LA QUINTA
78495 CALLE TAMPICO
LA QUINTA, CA 92253
Contractor:
CITY OF LA QUINTA - ALFRED BERUMEN
78495 CALLE TAMPICO
LA QUINTA, CA 92253
(760)777-7000
Llc. No.::AZA:1506030156221903
Detail: REMODEL EAST WING ROOM AT NORTH EAST CORNER(CURRENT TRAFFIC CONTROL OFFICE). REMOVE (2)PONY WALLS AND RELOCATED (2)
ELECTRICAL OUTLETS, ADD 4 IN -GROUND ELECTRICAL OUTLET AND (2) ETHERNET PORTS, AND ADD 3 RECESSED ELECTRICAL OUTLETS AND ETHERNET
PORTS AT NORTH SIDE WALL. PER 2016 CALIFORNIA ELETRICAL & BUILDING CODES.
FINANCIAL INFORMATION
40,FDES F,RT
PERMIT #
❑()L}
PLAN LOCATION:
.
Project Address: ]RqqS C4AJ1r-
Project Description:
Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:�Yi+tc3
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rr
e
Applicant Name: 6,n
OL L,,— �
p V\ q5C+�, OCIA
61 n 64 1 0 V Yt
Address: M PILL
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VcA o
City, ST, Zip: i r
Telephone:
Email:
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Clli,
Valuation of Project
Contractor Name:
►� � c G
Address: ` q q5o
City, St, Zip I u h, u LA. C, -afl
Telephone: Z lb — -7.5 = 0 I S S
Email:
State Lie: 4 8 i3 � City Bus Lic:
New SFD Construction:
Conditioned Space SF
Garage SF
Patio/Porch SF
Fire Sprinklers SF
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: } New Commercial / Tenant Improvements:
Address: Total Building SF
City, ST, Zip Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
i
here
Repair Drywall damage and scaring and
repaint with like color.
Mount Video Monitors and North Wall
and Dry Erase Board on West Wall.
Install recessed Electrical and Ethernet
receptacles at marked locations. For
Video Monitors. X Circuit #19
CITY OF LA QU NTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATEBY
Test Bench
X
i1 y LrC'Se board
X
40
Demo Desk and Pony Walls and
remove carpet.
Saw cut and remove concrete for
Electrical and Ethernet Conduits. Install
in ground outlets and -Ethernet ports.
* LA
Relocate Steel Racks to Yard Sto
Test Bench
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS C), [ �_�uj; PERMIT NUMBER OWNER „� a BUILDER
This form shall be posted on the job with the_8tlildinInspection Card at all times in a•consoicuousplace. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be competed by applicant. "On File" is not an acceptable response.
Trade 1 Cl.assificatior�
Con.tractgr. ,._
St.at:e Contractor's License ••
Workers Compensation Insurance
City 13u.s.iness. License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (Cz1Z
CONCRETE (.C•8)
FRAMING (C-5)
STRUCT. STEEL (C-51)
MASONRY (C-29)
PLUMBING (C-36)
LATH, PLASTER (:CG3.51
DRYWALL (G 91.
HVAC :(C-2Q):
na
ELECTRICAL, (C-10:)
U � aV� K�o� �l�l:
� Ci ��J J�
MO
A
0L1 U
113 1
!ROOFING (C-39)
SHEET NLE`CAL (:C-431:
FLOORING (:C-451
GLAZING: (C=97J
1NSULATIQN. (C:-2)