05-5093 (DEMO)(R
4
P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 11/18/05
Application Number: 05-00005093 Owner:
Property Address: 78370 HIGHWAY 111 STE 130A OMADISON PTM LA QUINTA
APN: 604-050-048- - - D 78370 HIGHWAY 111, STE. 200
Application description: DEMO - COMML/OTHER iLA QUINTA, CA 92253
Property Zoning: COMMUNITY COMMERCIAL
Application valuation: 0 NOV 181005
CITY OF LA QUINT Contractor:
Applicant: Architect or Engineer: FINANCE DEPT. AIKEN, WILLIAM JAMES
40025 CHOLLA
RANCHO MIRAGE, CA 92270
(760)880-8746
Lic. No.: 834232
I hereby affirm under penalty of perjury tJl at I am
Section 7000) of Division 3 of the Bu 'ness and
License Class: }3
Date:
CTOR'S DECLARATION
:r provisions of Ch
apt ommencing with
Code, and m nse is in full force and effect.
` - — OWNER -BUILDER DECLARATION
I hereby affirm under erjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 , Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, molish, 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 Contractor's 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).:
(_ 1 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 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.). '
1 _ 1 1, 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.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason
Date:
Owner:
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:
LQPERMIT
WORKER'S 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 r
Carrier EXEMPT / Policy Number EXEMPT
I certify that' e performance of the work 1 this permit is issued, I shall not employ any
per many manner so as t o t7e workers' compensation laws of California,
d agree that, if I shout ec o the yy'�orkers' com en ' _::s os_4 Sec ^
3j00 of the Labor C car py)Gva' ose provisions.
ARNIhG: SAI RP_'10 EC ' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
S EMPLOYE AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE R CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Ap tion 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 orpursuant as a result of this application,
the owner, and the applicant, each agrees shall defend, indemnify a old harmless the City
of La Quinta, its officers, agents aad ployees for any act or omission related t he work being
performed under or followin lance of this permit.
2. Any permit issued as a r t of this applicatio 0 e nu void if rk is no commenced
within 180 days fr date of issuance of dch�permi essatio wo 0-day5'4vI sub�ct
permit to cancel ion.
I certify that I have read t ' application and sta the ion is correct. I ree to comply with all
city and county ordina s and state laws re g ion, and hereby thorize representatives
of this coudiv toAnt don the above -m i tion purposes
Date: ,Signature
Application Number . . . . . 05-00005093
Permit . . . DEMO PERMIT
Additional desc .
Permit Fee 45.00
Plan Check
Fee
.00
Issue Date
Valuation
. . .
. 0
Expiration Date 5/17/06
Qty Unit Charge Per
Extension
BASE
FEE
45.00
----------------------------------------------------------------------------
Special Notes and Comments
SAW CUT & REMOVE CONCRETE/EXPOSE
SEWER
IN PREPARATION FOR TI CURRENTLY IN
PLAN
CHECK
Fee summary Charged
----------
Paid Credited
----------
----------
Due
---------------------------
Permit Fee Total 45.00
.00
.00
45.00
Plan Check Total .00
.00
.00
.00
Grand Total 45.00
.00
.00
45.00
k
RMA
Bin #
f
Permit
Project Address: -7,g .�>► 7 Q
A. P. Number:
Description:
Contractor:
I a
�'
City of La Quinta
Building u Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
SI -F, 3 C7 Owner's Name:
V C
Address: - 5-7O � "-70!5Legal
City, ST, Zip:
So RR q Telephone: --7 -7 t_
Address: '100 ? -K—
�
Project Description:
.�
City, ST, Zip.
Telephone: ?60 _ 880 - S-Im
P-ttlQ�
State Lic. # : 2 Z
City Lic. #:
tnGi
Arch., Engr., Designer: (f_A.NC>lGF S 0
Address: -�� . 7 )�£ S ><. Cif • S ,
City, ST, Zip:
.�
-� � c! 221
n
B�
D� 7o tSsvE (� l7Ae&''y I -r- /g•O
Telephone: -7co0 301 (o
State Lic. #:
_
Name of Contact Person: ®1
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: �s cJ
#Stories:
# Units:
Telephone # of Contact Person: j,
o c
gS O '3431
Estimated Value of Projec
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Plan Sets
Req'd
Recd
TRACKING .
Plan Check submitted
PERMIT FEES
Item Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading,plan
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Bin V
,%,kin City of La Quinta
uhw6pffi-b Building u Safety Division
Permit # P.O. Box 1504, 78-495 Calle Tampico
l�lo La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Project Address: -7,g
-7 O S"t'`f-, 3 C Owner's Name:
A. P. Number:
•V
Address: - 5-7 U 2 O ,
Legal Description: City, ST, Zip:
v i cv.
Contractor: Telephone: --7 -7
Address: 1�� G
t� Project Description: + .
City, ST, Zip. G ni..
Telephone: -?Co- $$0 _ s -IM,
State Lic. # cr 2 3 7 -
Arc h.,
Arch., Engr., Designer:Nl]iC
Address:
City, ST, Zip:' ,
Telephone: -?,r00 9wo rs0I (o
State Lic. #:
Name of Contact Person: 4�
Telephone # of Contact Person: —)
# I Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Energy Cales.
Flood plain plan
Grading_ plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN.HOUSE:-
Planning Approval
Pub. Wks. Appr
School Fees
City Lic. #:
f'l22.11
Z
Total Permit Fees
9
Construction Type:
Occupancy:
_
Project type (circle one):
New Add'n Alter Repair Demo
Sq. Ft.: �j�
# Stories:
# Units:
O 3,o I
Estimated Value Of•Proj
APPLICANT:
DO NOT WRITE BELOW. THIS LINE
Recd
TRACKING .
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2a4Review, ready for correctionsrissue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
'" Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees