08-0507 (TT)P.O. BOX 1504 4
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 8-00000507
Property Address: 45305 SEELEY -DRJ
APN: 604-040-075- - -
Application description: TEMPORARY TRAILER
Property Zoning: TOURIST COMMERCIAL.
Application valuation: 1000
Applicant: Architect or Engineer:
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 Professionals Code, and my License is in full force and effect.
License Class: B -C36 w License No.: 570943
ate: .O ntractor: e.
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).:
1 _ 1 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:..] ' 4:)L20 ®'
I hereby affirm under penalty of
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERA11T
Owner:
APPLECORE ENTERPRISES
P.O. BOX 969
MINOT, ND 58701 Fr
Contractor:
CLARK CONTRACTORS IN
26902 VISTA TERRACE
LAKE FOREST, CA 92630
(949)581-6577
Lic. No.: 570943
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 3/27/08.
U
MAK 2 7 200E
YY OF LA OW�uT. I
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' compensation
insurance carrier and policy number are:
Carrier PRAETORIAN INS Policy Number P0011020034143
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
�p 370s0rof the abor Code, I. shall forthwith comply with those provisions.
late: 3 'aJA pplicant: C �+
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 Director of Building and Safety 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 inform on is correct. I agree to comply with all
city and co my ordinances and state laws relating to building c struc on, d hereb presentatives
of thi un to enter upon th bove-mentioned proper y f ins cti n pur ses
ate:3"� ature (Applicant or Agentl:
Application Number 08-00000507
Permit . . TEMP TRAILER
/'MOBILE HOME
Additional desc .
Permit Fee 200':00
Plan Check
Fee
00•
Issue Date
Valuation.
0
Expiration Date.. 9/23/08
Qty Unit Charge .Per
Extension
BASE
FEE
200..00
Special Notes and Comments
TEMPORARY CONSTRUCTION TRAILER &
4
STORAGE BINS PER TUP #2008-800
Fee summary Charged
Paid Credited
Due '
Permit Fee Total 200.00
00
.00
200.00.
Plan Check Total .00
.00
.00
.00
Grand Total 200.00
.00
.00
200.00
LQPERN11T
Bin #
City of La Quints
Building 8t Safety Division
Permit .# P.O. Box 1504, 78-495 Calle Tampico
-
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address:' Owner's Name:
A. P. Number:
Address:
to
Legal Description:
City, ST, Zip: M Z a i $ 70
Contractor:CL '
K% ��r� '— Telephone:. Q e' �3
Address: 2r.
U r ' Project Description:
City, ST, Zip: 1 ,�
C.m s '
a to o
Telephone:
ZC— ib 10 S.1®��. sw'
State Lie. # 41 City Lic. #: r
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occu ancy
P
MF
State Lic. #: '
roject type (circle one): New Add'n Alter ' Repair Demo
Name of Contact Person:
ry Sq. Ft.: # Stories:.
#Units:
m p
Telephone # of Contact Person:'402"'o
S �— O Estimat=Valuef Pr *e 6
O Od
APPLICANT: DO NOT WRITE BELOW THIS LINE
# Submittal Req'd Recd TRACKING
. PERMIT FEES
•
Plan Sets Plan Check submitted Item
Amount
Structural Calcs. Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs. Called Contact Person
Plan Check Balance
Energy Calcs. Plans picked up
Construction
.:
Flood plain plan. Plans resubmitted
Mechanical
Grading.pian 2°" Review, ready for correctionslissue . Electrical
Subcontactor List Called Contact Person Plumbing
Grant Deed Plans picked up S.M.I.
H.O.A. Approval Plans resubmitted
Grading
IN HOUSE:- "d Review, ready for corrections/issue Developer Impact Fee
Planning Approval Called Contact Person A.I.P.P.
-----------------
Pub. Wks. Appr Date of permit issue
School Fees
-----------------------
Total Permit Fees