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04-6175 (SOTB)BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760).177-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 04-00006175 Date 2/01/05 Property Address . . . . 78370 HIGHWAY 111 APN: 604-050'-048- - - Application description . . . STRUCTURES OTHER THAN BUILDINGS Property Zoning . . . . . . . C_OMMUNITY COMMERCIAL Application valuation . . . . 4948 Owner ------------------------ Contractor MADISON PTM LA QUINTA ------------------------ PRIMUS CONTRACTING GROUP, INC 71361 SAN GORGONIO RD 1409 SO. 600 WEST, SUITE D RANCHO MIRAGE CA 92270 BOUNTIFUL UT 84010 WCC: STATE FUND WC: 17051812003 10/01/04 CSLB: 814726 11/30/04 -----------7---------------------------------------------------------------- CCC: B Permit . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 72.00 Plan Check Fee 46.80 Issue Date . . . . 11/05/04 Valuation . . . . 4948 Expiration Date . . 5/05/05 Qty Unit Charge Per Extension BASE FEE 45.00 3.00 9.0000 THOU BLDG ---------------------------------------------------------------------------- 2,001-25,000 27.00 Special Notes and Comments Temporary wood framed deck at construction trailer. (370 sqft) --.---------------------------------------------=---------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 4.68 Fee summary Charged ----------------- Paid Credited Due ---------- Permit Fee Total 72.00 ------------------------------ 72.00 .00 .00 Plan Check Total 46.80 46.80 .00 .00 Other Fee Total 4.68 4.68 .00 .00 Grand Total 123.48 123.48 .00 .00 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: Date: Architect or Engineer: Architect or Engineer's Address: Lic. No.: 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 License is in full force and effect. License Class License No. Date 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).): ( j 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. , 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 issued. My workers' compensation insurance carrier and policy number are: 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 Applicant 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.). 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. 1 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): prr wl' P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 January 31, 2005 To Whom It May Concern: y Q�rw BUILDING & SAFETY DEPARTMENT (760) 777-7012 FAX (760) 777-7011 Please be advised of an address change for the following, structure. Effective immediately, the structure formerly addressed as 78-380 Highway 111, APN: 604-050-048, Par 9, Parcel Map 197/028 PM 29736, is now addressed as: 78-370 Highway 111 This address change affects the following building permits in process or issued by the.City of La Quinta Building & Safety Department: 04-3803 04-6175 05-68 05-195 04-6013 04-68CY0' 05-113 05-258 04-6165 04-7122 05-196 It should also be noted that this parcel, along with assessor's parcels -049, -050 and -051, was part of Parcel Merger 2004-457, recorded on 4/30/04 by the Riverside County Recorder as instrument number 2004-0319136. It is anticipated that a new parcel number will be generated by the Riverside County Assessor's Office in the near future. Please note this change and contact me directly at (760) 777-7084 if I may be of further assistance. Sincerely, e4�e Kay Hensel Office Assistant ,