BSPN2019-001878-495 CALLE TAMPICO Ceitv, 0 4QaCU
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: SPECIAL INSPECTION/
Application Number: BSPN2019-0018
Property Address: 79410 HIGHWAY 111 STE 103
APN: 600390006
Application Description: SABATINOS PIZZA & PASTA / SPECIAL INSPECTION
Property Zoning:
Application Valuation: D
Applicant: SHERIDERRYBERRY
79410 HIGHWAY 111 SUITE 103 SEP 0 6 2019
LA QUINTA, CA 92253
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
E&DD
2114 ARI LN
LOS ANGELES, CA 92253
Contractor:
CITY OF LAQUINTA
DESIGN & DEVELOPMENT DEPARTMENT Llc. No.:
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
�I, as owner of the property, or my employees with wages as their safe
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
she dtd nat build or Improve for the purpose of sate.}.
, as ownerof 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
t reon, and who contracts for the projects with a contractor(s) licensed pursuant to
antractors' State License Law.
I am exempt under Sec. 13111.C. fork reason
rs
Date: O er:
_0 CONSTRUCTION LENDING AGENC
I hereby affirm under penalty of perjury that there is a constructio ending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's
Lender's Address:
Date: 9/6/2019
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:
Carr' 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 of the LabWshallith
comply with those provisions.
Date: �Applicant;
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION UL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF
COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,
INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose
request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application , the owner, and the applicant, each agrees to, and
shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to the work being performed under or
following issuance of this permit.
2. Any permit issued as a result of this application becomes null and void if work is
not commenced within 180 days from date of issuance of such permit, or cessation of
work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws vela ing to building
construction, and hereby authorize representatives oft to enterup the
above -mentioned property for Inspection purposes.
Date: �� Signature (Applicant or A$entj
Date: 9/6/2019
Application Number:
BSPN2019-0018
Property Address:
79410 HIGHWAY 111 STE 103
APN:
600390006
Application Description:
SABATINOS PIZZA & PASTA / SPECIAL INSPECTION
Property Zoning:
Application Valuation:
Applicant:
SHERIDERRYBERRY
79410 HIGHWAY 111 SUITE 103
LA QUINTA, CA 92253
Owner:
E&DID
2114 ARI LN
LOS ANGELES, CA 92253
Contractor:
Llc. No.:
Detail: SPECIAL INSPECTION FOR USE. NO WORK INSPECTION ONLY. 2016 CALIFORNIA BUILDING CODES
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT CITY
AMOUNT
SPECIAL INSPECTION
101-0000-42404 0
$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:
TOTALS:i
$5.00
oca Qw�ra
C kI [F0, iNIA
Project Address:
APN #:
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Applicant Name: Add ress: ��S�j ` -� Ck
City, ST, Zip: Ln
A
Telephone: /L.
Email` � 6 vv-Ww a ;
Property Owner's Name:
Address:
City, ST, Zip
Telephone:
Email:
Y
PLAN LOCATION:
�3 Project Description:
k
Project Valuation $
New Commercial / Tenant Improvements:
Total Building SF
Construction Type: Occupancy:
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
OFFICE USE ONLY
#
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Submittal
- f
Required Received
Plan Jets
-
Structural Calcs
Truss Calcs
Title 24 Calcs
CVWD Fire Flow Letter
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