10-0701 (SOTB).,. 1 IIIIIIIIVIIIIIIVIIIIIII 38
'
P.O. BOX 1504 ` IE
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
10-00000701
Property Address:
78115 AVENUE 52
APN:
770-184-003- - -
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
MAJOR COMMUNITY FACILITY
Application valuation:
56200
Applicant: Architect or Engineer:
Gqwwo-qoo- UA
.4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 07's: B /%/%� LicLnse No.: 813480
l: Date: �' / %� Contractor: /Li�{/�Z
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
fallowing 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 fcommencing 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 _) 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 oc 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.).
(_ 1 1, 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 I am exempt under Sec. , BAP.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:
LQPERMIT
Owner:
CITY OF LA QUINTA
P 0 BOX 1504
LA QUINTA, CA 92253
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Contractor: I
DAVIS/REED CONSTRUCTION INCi
12250 EL CAMINO REAL, STE # 5
SAN DIEGO, CA 92130
(858)523-9760
LiC. No.: 81.3480
Date: 10/20/10
u
NOV10 2010
1A QUINTA
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 TRAVELERS PROP Policy Number VTC2KUB5450D84A
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 fort 'th comply with those provisions.
Date: 0 Applicant: gae
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 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 colyty
t enter upon the above-mentioned pr pert r inspec urpos
Date#' /V b Signature (Applicant cr Agent):
' Application Number .
. . . . 10-00000701
Permit . . .
BUILDING PERMIT
Additional desc
Permit Fee . . . .
446.00 Plan Check Fee
289.90
Issue Date . . . .
Valuation . . .
. 56200
Expiration Date
4/18/11
Qty Unit .Charge
Per
Extension
.
BASE FEE
414.50
7.00 4.5000
--------------------------------=--'-----------------------------------------
THOU BLDG 50,001-100,,000
31.50
Permit . . .
ELEC-MISCELLANEOUS
Additional desc . .
Permit Fee . . . .
47.75 Plan Check Fee
11.94
Issue Date . . . .
Valuation
0
Expiration Date
4/18/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00
19.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20
14.25
1.00 18.5000
EA ELEC SVC <=600V/<=200A
18.50
----------------------------------------------------------------------------
Special Notes and Comments
(19) LIGHT STANDARDS
AT CITY YARD/FIRE
STATION 32 - 2007 CALIFORNIA
BUILDING
CODES.
September 22, 2010 12:21:23
PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . .
. . . . BLDG STDS ADMIN (SB1473)
3.00
ENERGY REVIEW FEE
28.99
STRONG MOTION (SMI) - COM
11.80
Fee summary Charged
---------------------------
Paid Credited
------------------------------
Due
Permit Fee Total
493.75 .00 .00
493.75
Plan Check'Total
301.84 .00 .00
301.84
Other Fee Total
43.79 ..00 .00
43.79
Grand Total
839.38 .00 .00
839.38
LQPERMIT
Bin #
City of is Quin1.Q
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:,. 1195 AVSWF,
C2
Owner's Name: Cjf
A. P. Number: ^
Address: 19•4c1S 6A4A+j'rM&*Py p
Legal Description:
City, ST, Zip:
Contractor:
Address: 1,% 0 66-
�
kS44, .St6 125
e
Tlephone:
•; •
3 4.�
Project Description: A LAL.AAI
City, ST, Zip: Ll
9iA30
Telephone• .47s�.,
� "; :��y�.��f �"�,,; •; �' �
.
State Lic. # :
City Lic. #;8134
Arch., Engr., Designer.
Address:
City., ST, Zip:
Telephone:
State Lic. #
Name of Contact Person:
F
« "s ?j
i J.{l.n`rJi'.%%i �J�(f5 ...• v$iti�% i\
'
Construction
Type:
Occupancy:
pro'ecttyp): ep a circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
Estimated Value of Project: 5�. °� Q;la JE -
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Caics.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Y�
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctionsfissueI
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up.
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
.._
IN HOUSE:-
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