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04-3777 (RC)P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT Application Number Property Address APN: Application description Property Zoning . Application valuation . Owner ------------------------ ND LA QUINTA PARTNERS 375 N FRONT ST STE 200 COLUMBUS OH ------ Structure Information Construction Type . . . Occupancy Type . . . . Flood Zone . . . . . . Other struct info . . . IIIIIIIIVIIIIIIVIIIIIII 26 IE BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 X04-00003777 Date 4/28/04 . . . 80955 AVENUE 52 772-410-014-C -29894 . . . REMODEL - COMMERCIAL = —� . . . LOW DENSITY RESIDENTIAL . . . 12000 Contractor M -------------�-- -=._==---- " A & M CONSTRUCTION P.O. BOX 366 43215 LA QUINTA CA 92253 (760) 564-4832 WCC: STATE FUND WC: 0460009232 01/01/05 CSLB.: 746198 02/28/06 CCC: B -C10' ROOF MOUNTED A/C SCREEN ----- TYPE V - NON RATED GAR, CARPORT, SHED, AG NON -AO FLOOD ZONE CODE EDITION 2001 CBC FIRE SPRINKLERS YES ---------------------------------------------------------------------------- Permit . . BUILDING PERMIT Additional desc Permit Fee . . . . 135.00 Plan Check Fee 87.75 Issue Date Valuation 12000 Qty Unit Charge Per. Extension BASE FEE 45.00 10.00 9.0000 THOU BLDG 2,001-25,000 90.00 - --------------------------------------------------------------------------- Special Notes'and Comments ROOF MOUNTED A/C SCREEN WALLS PER CDD APPOVED PLANS 2001 - -----=--------------------------------------------------------------------- Other Fees . . . . . . . . STRONG MOTION (SMI) - COM 2.52 Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total 135.00 .00 .00 135.00 Plan Check Total 87.75 .00 .00 87.75 Other Fee Total 2.52 .00. .00 2.52 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: o Z ► — ':� 7 Applicant: Applicant's Mailing Address: Date: 1129100,, Architect or Engineer: Architect or Engineer'sMdress: 1g�v � l6 Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I a icensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my Lice n ,is in II force and effec Ll r + n� License Class License No. '^I l "I Date U Contractor 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 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.). U I am exempt under Sec. , BA P.C. for this reason Date WORKERS' 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 i ued. ALy w r corrnsation insurance carrier and polic u ber are; Carrier (1/'1Tfl—t (/ Policy Number /) dD r1 _ I certify that, in the performance of ta�nagree ork forwhich this permit i issued, I s all not employ any person in any manner so as to become subject to the workers' compensation laws of California, that,if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provi. c ' Date J %, -! I 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. CONSTRUCTION LENDING AGENCY 1 hereby affirm under penaltyofperjury 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 Jinformation 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 count o enter upo; the above-mentioned property for inspection purposes. Date 3 Signature (Applicant or Agent): Application Number 04-00003777 Grand Total 225.27 .00 Page 2 Date 4/28/04 00 225.27 La CITY OF LA QUINTA BUILDING & SAFETY DEPARTMENT 777-7012 INSPECTION REQUEST LINE 777-7153 Owner ND LA QUINTA PARTNER LLC Contractor A & M Permit Number-3fi7.rZ��? POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE -SPACES JOB ADDRESS 80-955 AVE- 52 ' - — A/C SCREEN PER CDD APPROVAL TYPE OF INSPECTION DATE --4 SP. TEMPORARY POWER SETBACKS U/G PLUMBING / WASTE U/G ELECTRICAL / GROUNDING FOOTINGS / STEEL CONCRETE SLAB DO NOT POUR CONCRETE UNTIL ABOVE SIGNED ROOF NAIL / PRE -ROOF OKAY TO WRAP / 'AMING COMBINATION / .TOUGH ELECTRIC ROUGH PLUMBING ROUGH MECHANICAL INSULATION COVER NO WORK UNTIL ABOVE SIGN INTERIOR GYP. BD. DRYWALL EXTERIOR LATH v IV GAS TEST SEPTIC. ABANDONMENT SEWER CONNECTION SEPT / GREASE INTERCEPTOR MASONRY INSPECTIONS FOOTINGS / STEEL BOND BEAM POOL / SPA / WATER FEATURE INSPECTIONS PRE-GUNITE / SETBACKS U/G PLUMBING .0/G ELECTRICAL PRE -PLASTER ALARMS / BARRIERS FINAL INSPECTIONS TEMP. USE OF�PERMANENT POWER ELECTRICAL "'.UMBING _CHANICAL A PUBLIC WORKS DEPARTMENT COMMUNITY DEVELOPMENT DEPT. FINAL / JOB COMPLETED ABOVE APPROVALS no N1 INCLUDRI TO TURN ON UTILITIES OR OCCUPY B NG