05-1177 (BLCK)TA t • UkrC4j
BUILDING & SAFETY DEPARTMENT
ox 1504(1�i P. (760),777-701 2 '
7 4 5 $PRL12 �JAW0 FAX (760) 777-7011
L Q INTA A 922 3 INSPECTION REQUESTS (760) 777-7153
CI Y O
FINANCE DEQ•
UILDING PERMIT
Application Number
Property Address . . .
APN:
Application description
Property Zoning . . . .
Application valuation .
. . CO -5--0-0-001177_j
111
643-020-999-6 -30903 -
. . . WALL/FENCE
. . . REGIONAL COMMERCIAL
. . . 1100
Owner
------------------------
WASHINGTON 111 LTD
C/O JOHN ANDERHOLT
P 0 BOX 1623
PALM DESERT CA 92261
Date 4/14/05
Contractor
MOOREFIELD CONSTRUCTION, INC.
3415 S. SEPULVEDA BLVD STE 550
LOS ANGELES CA 90034
(3 10) 390-9400
Fee summary Charged
Permit Fee Total 27.00
Plan Check Total .00
Other Fee Total 70.50
Grand Total 97.50
Paid Credited Due
---------- ---------- ----------
..00 .00 27.00
.00 .00 .00
.00 .00 70% 50
.00 .00 97.50
WCC:
STATE FUND
WC:
1686016-2005
03/31/06
CSLB:
397892
02/28/07
a
CCC:
B
----------------------------------------------------------------------------
Permit .
. . . . . WALL/FENCE PERMIT
Additional
desc
Permit Fee
. . . . .27.00
Plan
Check Fee
.00
Issue Date
. . . ..
Valuation . . . .
1100
Qty
Unit Charge Per
Extension
BASE FEE
> 15.00
6.00
2.0000 HND BLDG 501=2,000
12.00
--------------------------------------------------------------------------
Special Notes
and Comments
44 LF. 10'
HIGH SCREEN WALL AT TRASH
,
COMPACTOR
----------------------------------------------------------------------
PER ENGINEERING PLAN
Other Fees
. . . . . . . . . HOURLY
PLAN CHECK
------
70.00
STRONG
MOTION
(SMI) - COM
.50
Fee summary Charged
Permit Fee Total 27.00
Plan Check Total .00
Other Fee Total 70.50
Grand Total 97.50
Paid Credited Due
---------- ---------- ----------
..00 .00 27.00
.00 .00 .00
.00 .00 70% 50
.00 .00 97.50
P.O. BOX 1504 • ����G
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 = - _ INSPECTIONS (760) 777-7153
BUILDING & SAFETY, DEPARTMENT - -
r�,,j
Application Number:
Date:
Applicant: '-- Architect or Engineer:
Applicant's Mailing Address:
(/8h�71-,A K_Zd �
Architect'or Ehineer'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 ir�,fu11 force and effect.
icense Class b� --me No.
CJDate / Contractor iD�
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. , B.& P.C. for this reason
Date Owner
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
}ssued. MA workers' compensation insurance carrier and policy number are:
Carrier J%isZt n..../ / Policy Number 16FA I Zodlq—
_ I certify that, in the performance of the work for which this permit is issued, 1 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.
Y- Zs-.�s ` 5�--
Date Applicant
WARNING: FAILURE O 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
Lenders 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 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.
4�zs� r�
Date Signal re (Applicant or Agent): d31�T
t
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
(760) 777-7012
FAX�(760) 777-7011
To: Greg Butler, Building & Safety Manager To CDD: 03/30/05
From: Doug Evans, Planning Director Due date: 04/13/05
Status:
Building Plans Approval
(This is an approval to issue a Building Permit) .
The Community Development Department has reviewed the Building Plans for the
following project:
Description: Trash Compactor - Screen Walls
Address or general location: 78-987 HIGHWAY 111 (Office Depot)
Applicant Contact: Bill Sanchez 485-5308
The Community Development Department finds that:
❑ ...these Building Plans do not require Community Development Department
appEoViLl.
these Building Plans are approved by the Community Development
Department. a
❑ ...these Building Plans require corrections. Please forward a copy of the attached
corrections to the applicant. When the corrections are made please return them to
the Community Development Department for review.
&o-u--g--Evans, Planning hector Date