BSPN2019-0024T4ht
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1�i/ VOICE (760) 777-7125
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
INSPECTIONS (760) 777-7153
BUILDING PERMIT
Permit Type/Subtype: SPECIAL INSPECTION/ Owner:
Application Number: BSPN2019-0024 LA QUINTA RESORT
Property Address: 50200 AVENIDA VISTA BONITA
APN: 773021006
Application Description: GRIFFIN / GENERATOR FOR TED EVENT
Property Zoning:
Application Valuation: $0.00
Applicant: Contractor:
BRUDVIK INC BRUDVIK INC
600 EUGENE ROAD 600 EUGENE ROAD
PALM SPRINGS, CA 92264 NOV ,2 6 2019 D PALM SPRINGS, CA 92264
0-4429
C�4F LAQUINTA LI 60No?: 82623
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: C10 License No.: 482623
e`�� 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.).
(_) 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:
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 Address:
Date: 11/26/2019
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 thW10 for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section OO 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: EVEREST PREMIER INSURANCE 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.
Ant:Va
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.
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. /
054" % ' Sign'dt (Applicant or Agent): /1
Date: 11/26/2019
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
BRUDVIK INC
600 EUGENE ROAD
PALM SPRINGS, CA 92264
BSPN2019-0024
50200 AVENIDA VISTA BONITA
773021006
GRIFFIN / GENERATOR FOR TED EVENT
$0.00
Owner:
LA QUINTA RESORT
Contractor:
BRUDVIK INC
600 EUGENE ROAD
PALM SPRINGS, CA 92264
(760)320-4429
Llc. No.: 482623
Detail: SPECIAL INSPECTION FOR TED EVENT GENERATOR / POWER. PER 2016 CALIFORNIA BUILDING CODES
DESCRIPTION
FINANCIAL INFORMATION
ACCOUNT CITY
AMOUNT
SPECIAL INSPECTION
101-0000-42404 0
$80.50
Total Paid for COMPLIANCE SURVEY/SPECIAL INSPECTION:
$80.50
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE:
TOTALS:
$5.00
Contractor Name: gj6N D Construction:
Address: itioned Space
City, St, Zip eTelephone: PorchEmail:prinklersState Lic: City Bus Lie: Zt
Arch/Eng Name:
Address:
City, St, Zip
Telephone:
Email:
State Lie:
Property Owner's Name:
Address:
City, ST, Zip
Telephone:
Email:
City Bus Lie.
Construction Type:
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)777-7125
W W W. LAQUI NTACA.GOV
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BRUDVIK, INC. 60&wcs-
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600 EUGENE ROAD
PALM SPRINGS, CA 92264
PHONE: (760) 320-4429
FAX:(760) 323-3302
LICENSE #482623
• GeV,
***IDENTIFICATION CARD***
MAKE
RAJYS SPECIAL VEHICLE
BODY TYPE MODEL MO TYPE VEHICLE USE
SPMBL XU MOBIL EQUIP
DATE ISSUED CC/ALCO DT FEE RECVD PIC
07/05/16 33 07/01/16 1
REGISTERED OWNER
BRUDVIK INC
600 S EUGENE RD
PALM SPRINGS
CA 92264
SELLER'S
SIGNATUR
DATE SOLD /
EXPIRES: 12/31/2020
TYPE VEH TYPE LIC LICENSE NUMBER
02Z E5 SE678091
VEHICLE ID NUMBER
5UABU1212FV003379
STICKER ISSUED
814982Y
AMOUNT PAID
$ 25.00
.AMOUNT DUE AMOUNT RECVD
`= 25.00 CASH
w� CHCK
CRDT
-------------------------
CARRY THIS DOCUMENT OR
A COPY WHEN
OPERATING THIS VEHICLE
. --- _-_-------------------�-
E20 134 E2 0002500 0015 PS E20 070516 E5 SE678091 379
TL: E5 LIC#: SE678091 VIN: 379 FC: S
********************************************
- * I N S T R U C T I 0 N S
THIS IS NOT AN APPLICATION FOR TRANSFER
* IMPORTANT * * IMPORTANT * * IMPORTANT
IF THIS VEHICLE IS DESTROYED OR SOLD TO ANOTHER PERSON, YOU MUST COMPLETE
THE NOTICE BELOW. THE COMPLETED NOTICE MUST BE RETURNED TO THE DEPARTMENT
WITHIN TEN DAYS AFTER SALE OR DESTRUCTION OF THE VEHICLE. (SEC. 5017
VEHICLE CODE)
CHECK ONE: ( ) VEHICLE DESTROYED ( ) VEHICLE SOLD TO:
(COMPLETE BELOW)
PURCHASER'S
(LAST) (FIRST) (MIDDLE)
ADDRESS
CITY STATE
SELLER'S SIGNATURE tF, DATE SOLD / /
MAIL COMPLETED NOTICE TO:
DEPARTMENT OF MOTOR VEHICLES
P.O. BOX 942869
SACRAMENTO, CA 94269-0001
RQCAL t-ORN IA
AIR RESOURCES BOARD
Legal Owner or Operator:
Mailing Address:
Engine Description:
Mary D. Nichols, Chair
Matthew Rodriquez, CalEPA Secretary
Edmund G. Brown Jr., Governor
Statewide Portable Equipment
Registration
Registration No: 169147
Brudvik, Inc.
600 Eugene Road
Palm Springs, CA 92264
Certified portable internal combustion engine, compression ignition, manufactured by Kubota, model V3800-CR-TIE413-
BGHE1, serial no. 2EW6187, (Chit Number: #65), rated at 90 bhp, Diesel fueled.
U.S. EPA Engine Family Name:
Conditions:
Home District:
Engine Inspection Discount:
EKBXL03.8AMC
see attached
South Coast Air Quality Management District
No inspection discount claimed
77 T ration Date: July 31, 2021
r
y M. Weatherford
Eiger, Portable Equipment Registration Section
rcement Division
arb.ca.gov 1001 1 Street 9 P.O. Box 2815 0 Sacramento, California 95812 (800) 242-4450
Bobb►► Headle
From: Linda Jenkins <Ijenkins@signatureparty.com>
Sent: Thursday, November 21, 2019 1:41 PM
To: Bobby Headley
cc: Linda Jenkins
Subject: TED generator Dec 3 Mountain Dunes Clubhouse
Importance: High
Hey Bob,
0
Looking at the diagram they just sent the genie will be further away from the tent than I thought. That's got fa:°,
be about 125-150 ft. Please add more cable and send revised invoice!
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