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04-4696 (CONR)j I IIIIII VIII III VIII IIII 26 IE BUILDING & SAFETY DEPARTMENT P.O. Box 1504 JV (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 77.7-7153 Qty Unit Charge Per BASE FEE Extension 15.00 ti., BUILDING PERMIT Application Number . . . . . ,"04-00004696, Date 8/09/04 Property Address.,. 79999`AVENUE 52 ' APN: 772-290-007- -000000- Tenant nbr, name . . . . . . 'TEMP CLUBHOUSE RR',, Application description . . . NEW COMML - OTHER NON-RESIDENTIAL Property Zoning . . . . . . . GOLF COURSE Application valuation 41412 Owner Contractor ------------------------ LA QUINTA REDEVELOPMENT ------------------------ AGENCY DAVIS/REED CONSTRUCTION INC 78495 CALLE TAMPICO 169 SAXONY ROAD, STE #105 LA_QUINTA CA 92253 ENCINITAS CA 92024 (760) 634-2350 WCC: STATE FUND WC: WC298892004 06/12/05 CSLB: 813480 10/31/04 CCC: B -------------------------- Structure Information ------------------------- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . BUSINESS <50 Flood Zone . . . . . . . . FLOOD ZONE AO Other struct info *. . . . CODE EDITION 2001 FIRE SPRINKLERS YES MIXED-USE OCCUPANCY B PATIO SQ FTG 12.0.00 FIRST FLOOR SQ FTG ' 504.00 ---------------------------------------------------------------------------- Permit . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 362.50 Plan Check'Fee 235.63 Issue Date Valuation . . . . 41412 Qty Unit Charge. Per Extension BASE FEE 252.'00 17.00 6.5000 THOU BLDG 25,001-50,000 110.50 ---------------------------------------------------------------------------- Permit . . . . . . ELEC-NEW COMMERCIAL Additional desc Permit Fee . . . . 25.48 Plan Check Fee 6.37 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per BASE FEE Extension 15.00 ti., P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: n I ' I1 -J K LA. Applicant's Mailfnj Address: L� �vta-fo.) GA qu�7- 15D Date: ��/f_ / co) Architect or Engineer: TT gc=.. ��_�14 �. Archltect or Engin err Address: -S S!57 �LA casc2gh �IA ld t�.g CA Lic. No.: 33 0!J BUILDING PERMIT DECLARATIONS 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 Licens ' in full force and effect. Lice a Class License No.l ate C rector OWNER -BUILDER DECLARATION .I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 1, 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 or 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.). U I, as owner of the property, am exclusively c=ontracting 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. . U I am exempt under Sec. & C. for this reason Date `� Owner WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: — I t !a a 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 issue . Myw rkers' compensation insurance carrier an policy numb r are: Carrier rc. f ber j) Policy Num�" �7,18 1sad- I terfIfy that, in the performance of the work for which this pernit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Californi : a d agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with these pr vise ris. WARNING: FAILURE TO SECURE WORKER 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. 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 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 in ion is correct. I agree to comply with all city and county ordinances and state laws relating to building ;ate nst t tion, and hereby authorize re esentatives of this county a err po the ove ntir ed property for inspection purposes. nature (Applicant or A Agent): ) Page 2 Application Number . t . . . . 04-00004696 Date 8/09/04 Qty. Unit Charge Per Extension 524.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 10.48 ---------------------------------------------------------------------------- Permit . . . . . . MECHANICAL Additional desc . Permit Fee . . . . 51.00 Plan Check Fee 12.75 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.0000 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH B/C <=3HP/100K BTU 18.00 ----------------------7----------------------------------------------------- Permit . . . . . . PLUMBING Additional desc Permit Fee . . . . 105.00 Plan Check Fee 22.50 Issue Date . . . . Valuation . . . . 0 Qty. Unit Charge Per Extension BASE FEE 15.00 12.00 6.0000 EA PLB FIXTURE 72.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 ------------------------------------------------------------------•---------- Permit . . . GRADING PERMIT Additional desc Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments NEW RESTROOM BUILDING ADJACENT TO TEMPORARY CLUBHOUSE- "B" OCC. TYPE V -N CONSTR.- 504 SQ.FT AND TRELLIS =120 SQ.FT. 2001 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -COM 187.06 DIF CIVIC CENTER - COMM 47.88 ENERGY REVIEW FEE 23.56 Page 3 Application Number . . . . . 04-00004696 Date 8/09/04 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . DIF FIRE PROTECTION -COMM 16.12 STRONG MOTION (SMI) - COM 8.69 DIF STREET MAINT FAC -COMM 11.59 DIF TRANSPORTATION - COMM 868.89 Fee summary ----------------- Charged ---------- Paid Credited ------------------------------ Due Permit Fee Total 558.98 .00 .00 558.98 Plan Check Total 277.25. .00 .00 277.25 Other Fee Total 1163.79 .00 .00 1163.79 Grand Total 2000.02 .00 .00 2000.02