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RC (06-3930)78126 Main St 06-3930 } 760 P.O. BOX 1504 VOICE ( ) 777-7012 • y 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 11/27/06 Application Number: X06'06003930 ­ Owner: Property Address: 78126 MAIN ST OLD TOWN LA QUINTA. APN: 770-123-001- - - 78015 MAIN ST #205 Application description:. REMODEL - COMMERCIAL LA QUINTA CA Property Zoning: VILLAGE COMMERCIAL LA QUINTA, CA 92253 , Application valuation: 12500 - Contractor: D Applicant: Architect or Engineer: PRIMUS CONTRACTING GROUP IN G 1409 SO. 60.0 WEST,.SUITE D O BOUNTIFUL, UT 84010 (801)693-7270 Lic. No.: 814726 Nov 9 900 cF - LICENSED CONTRACTOR'S DECLARATION - WORKER'S COMPENSATION DECLARATION - hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing, with - I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided' - License Class: B License No.: 814726 for by Section -3700 of the Labor Code, for the performance of the work for which this permit is /' I /, , issued. Date: f /-Contra_ctor: (/f/./ L `L GU _ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor (fes-• Code, for the performance of the work for which this permit is issued. My workers' compensation OWNER -BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the Carrier STATE FUND Policy Number 0015781-2006 following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section ,. License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall forthwith comply with tflose provisions. that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by 9J/" _ any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:(Date. f `Applicant:. (_ 1 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 6 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does. not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND - and who does the work himself or herself through his or her own employees, provided that the DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN r improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). APPLICANT ACKNOWLEDGEMENT 1—) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec: IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of conditions and restrictions set forth on this application. property who builds or improves thereon, and who contracts for the projects witti•a contractor(s) licensed 1. Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit issued as a result of this application, ' I—) I am exempt under Sec. B.&P.C. for this reason 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. Date: Owner: 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 ` CONSTRUCTION LENDING AGENCY permit to cancellation.. I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the I certify that I have read this application and state that the above information is correct. I agree to comply with all ` work for which this permit is issued (Sec. 3097, Civ. C.). 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 innsspec tioonnnpurposes. e Lender's Name: ,./ /4 Z_' `^ .`Dae:/1 _Si'gnature (Applicant or Agent). TiC w . Lender's Address:' LQPERMIT Application Number . . . . . 06-00003930 J J Permit BUILDING PERMIT Additional desc . Permit Fee . . . . 144.00 - Plan Check Fee 93.60 Issue Date Valuation 12500 Expiration Date 5/26/07 +' Qty Unit Charge Per Extension BASE FEE 45.00. 11.00 9.0000 THOU BLDG 2,001-25,000 --------------------------------------=------------------------------------- 99.00 Permit ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 18.00 Plan Check Fee 4.50 Issue Date - Valuation . . . . 0 Expiration Date 5/26/07 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 .7500 EA ELEC POLE LIGHT 3.00 ------------------------------------------------------ Special Notes and Comments ---------------------- / light standards for parking lot -----------------_---------------------------------------_----------------- Other Fees . . . . STRONG MOTION (SMI) COM 2.62 Fee summary Charged Paid ----------------- Credited Due Permit Fee Total 162.00 .00 .00 162.00 Plan Check Total 98.10 .00 .00 98.10 Other Fee Total 2.62 .00 .00 2.62 Grand Total' 262.72 .00 .00 262.72 LQPERMIT Bin Y " -city of La Quinta Building u Safety Division Permit f( (:3930 78•/L6 P.O. Box 1504, 78-495 Calle Tampico d6' 3931-78' Y La Quinta, CA 92253 - (760).777-7012 Building Permit Application and Tracking Sheet Project Address: ? /Z6 /H R, Noti Mai .i S% SovR Pj% Owner's A. P. Number. Address: Legal Description: City, ST, Zip: Contractor: Telephone: t Address: ' Project Description: City, ST, Zip: % , • . ` l E'J i Telephone: 7 State Lic. # : CityLic. #• Arch., Engr., Designer: Address: OA City,: ST, Zip: 4 Telephone: —A Construction TV N pccup State Lic. #: Project type (circle one): New Add'n Alter • 'Repair Demo Name of Contact Person: Sq. FL: #Stories: #Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd _ : Reed TRACING .. PERMIT FEES 2, Plan Sets Plan Check submitted Item p Amount Structural Calcs. Reviewed,.ready for Plan Check Deposit . Truss Calcs. Called Contact Person Plan Check Balance Energy .Cales. Plans picked up Construction Flood plain glad Plans resubmitted Mechanical Grading plan 2" Review, ready for correc ' Assue Electrical $YbCOntaCtOr List Called Contact Person Plumbing Grant Deed .. Plans picked up S.M.I. Ii.O.A. Approval Plans resubmitted. Grading INHOUSE:- '''Review, ready for correctionsrssue Developer Impact Fee.. ; Planning Approval Called Contact Person A.LP.P. Pub. Wks. Appr Date of permit issue ( School Fees ,;: •. :..., Total.PermitFees : .. • // 8 /ob cDl w// /ar 9 rt n9 i