04-5729 (CONR)78065 Main St
04-5729
J
U
- f1 BUILDING & SAFETY DEPARTMENT
5w / P--.IOI: Boxl l 04
(760).777-7012
I E TAMPICo FAX 760 777-7011
p '9 7A611U41
5 C ( )
UG O N I A, CALIFORNrA 92253 IN REQUESTS (760) 777-7153
CITY OF LA QUINTA
"FINANCE DEPT BUILDING PERMIT:.
Application.Number 04-000_05_7.29___ _ Date 7/27/04
Property Address . . 78-0-65 MAIN ST
APN: 770-121-00'3-
Application
70-121-00'3 Application description NEW COMML -;OTHER NON-RESIDENTIAL
Property Zoning . . . . . VILLAGE COMMERCIAL
Application valuation:. . . . 706
Owner Contractor.
-- - - - - - - - - - - - - - - - - - - - - -------.-, -----.------------
OLD TOWN LA-QUINTA - MARVIN INVESTMENTS, INC.
78.080 CALLE ESTADO #200 78080 CALLE ESTADO SUITE 201
LA.QUINTA CA LA QUINTA CA 92253
LA QUINTA CA 92253
WCC: STATE FUND
WC: 14401252004 07/01/05
CSLB: 771883 11/30/05
CCC: B
------ Structure Information ELECTRICAL ROOM ADDITION -----
Construction Type . . . . . TYPE V - 1 HR
Other struct info . . . . . CODE EDITION 2001
FIRST FLOOR SQ FTG 36..00 ,
Permit . . . . . . BUILDING PERMIT
Additional desc
Permit Fee 21,.00, Plan Check Fees. 13.65
Issue Date Valuation . . 706
Qty Unit Charge Per Extension
BASE FE_ 15.00
3.00 2 . 0000 HND'' BLDG .5 . 01 22, 00.0 6.00
Permit, . . . ELEC-NEW COMMERCIAL
Additional desc
Permit- Fee 15.72 Plan Check Fee 3.93
Issue Date . . . . Valuation . . . . •0
Qty Unit Charge Per Extension
BASE FEE 15..00
3.6.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL .72
----------------------------------------------------------------------
Special Notes and Comments
--'Electrical Room Addition 36 sqft., with
.800 amp service.
c(F
ot
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:
Applicant's Mailing Address:
ril
Date:
Architect o ine
Architect E n ddress:
/"5 - ,9/wz r} $
Lic. No.: 6y
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of 9 MMmencing with Section 7000) of Division 3 of the Business and Professionals
Code, and my License,* in full force'and effect. op J
License Class J License No.
Date 176-36-0 - Contractor / ' 1 /✓ G
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 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 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. a , BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perl'ury 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 haveand
will maintain workers' compensation insurance,
as pre quiirreddbbyy Section 37!000 of the Labor Code, for the performance of the work for which this permit is
c5y/C y% G( y nsation insurance tamer/ 7`)`66 5 MV 1
Carrier 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.
Date i3(/ o / Applicant /V
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
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.).
Lenders 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, indemnity and hold harmless the City of La Ouinta, 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 county to enter upon the above-mentioned property for inspection purposes.
Date Signature (Applicant or Agent):
Page
2
Application Number
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. . . . .
04-00005729
Date
7/27/04
Other Fees . .
. . . . . .
ART IN PUBLIC
PLACES -COM
.00
STRONG MOTION
(SMI) - COM
.50
Fee summary
Charged
Paid
Credited Due
Permit Fee Total
36.72
.00
.00
36.72
Plan Check Total
17:58'
.00
.00
17.58
Other Fee Total
.50
.00
.00
.50
Grand Total
54.80'
.00
.00
54.80