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04-7753 (SOTB)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 04-00007753 Property Address: 79050 HIGHWAY 111 APN: 649-820-999- - - Application description: STRUCTURES OTHER THAN BUILDINGS Property Zoning: REGIONAL COMMERCI � Application valuation: f IIl1 Applicant: O FEB 2 2hite' Engineer: A� . `, OfLApi9PT. FIINTA NANCE �gp4. �j LICENSED CONTRACTOR'S DECLARATION 7 t 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 Prof sionals Code, and my License is in full force and effect. License Class: B J License No.: 572657 \ Date: 2 .T3 Contractor: OWNER-BUILDER DECLARATION ' I hereby affirrri under penalty of perjury that I am exempt from the Contractor's 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 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.). (_) 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.). 1 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: LQPERMi1T Owner: FOURTH QUARTER PROPERTIES 45 ANSLEY DR NEWNAN, GA 30263 (760)613-3783 Contractor: VRATSINAS CONSTRUCTION CO. P.O. BOX 2558 LITTLE ROCK, AR 72203, (501)376-0017 LiC. No.: 572657 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/02/05 ----------------------------------------------- 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' comperisation insurance carrier and policy number are: Carrier ZURICH INS Policy Number WC531636300 _ 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 shat/orthwiitt�h�comply with those provisions. `Date: �/73 _ � / Applicant: /jiLd �//J/cl�Y/.f 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. 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. 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 constru7tion, and hereby authorize representatives ofthis county to enter upon the above-mentioned pro oparrttyyy for inspe ion purposes.. Date;? ,T O� Signature (Applicant or Agent): H//A�f LQPERI%IIT Application Number . . . . . 04-00007753 Structure Information Construction Type ---------------------------------------------------------------------------- . . . . . TYPE V - NON RATED Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 99.00 Plan Check Fee 64.35 Issue Date . . . . Valuation . . . . 7650 Expiration Date.. 5/31/06 Qty Unit Charge Per Extension BASE FEE 45.00 6.00 9.0000 THOU BLDG 2,001-25,000 54.00 ---------------------------------------------------------------------------- Special Notes and Comments 9-7.33 FT X 20FT CMU BLOCK TRASH ENCLOSURES (Note: 3 have Trellis Structure)FOR PAVILION SITE. 2001 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . HOURLY PLAN CHECK 210.00 Fee summary Charged Paid Credited ------------------------------ ---------- Due ----------------- Permit Fee Total 99.00 .00 .00 99.00 Plan Check Total 64.35 .00 .00 64.35 Other Fee Total 210.00 .00 .00 210.00 Grand Total 373.35 .00 .00 373.35 �'�� City of La Quinta Building S Safety Division #P.O. Box 1504, 78-495 Calle Tampico V La Quinta, G 92253 - (760) 777-7012 ' -77- Buildin Permit Application g pp and Tracking Sheet Project Address: �ut t,t, F-nce Name:-- ate 0 A. P. Numberl e ]r -RV i 1io11 �'ULH, Address: . Leval Description:-ds� City. ST. Zip:✓ 9r Zocr Contractor. 'r e;0 Telcphone:ct M .- :;�{.'"I Address: Project Description: a a los . 4%)vn.•-� Z� &A -A. Cite, ST. Zip: l Telephone:AAA i.. tL State Lie. N : City Lie. p: Arch.. Engr.. Designer 1M IA COKIIu Address: =0 Sk ptap. Zyp Cite. ST. Zip: '�24v1 D T oen Telephone:JYj(- C7�tjQ State Lie. M: S/f>e. j r 4' 7 -'M -4;s !a c Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: I-MOA^V �� Sq. Ft.: Stories: d Units: Telephone # of Contact Person:` ,� �[3 stimated Value of Proicct: 26 APPLICANT: DO NOT WRITE BELOW THIS LINE a Submittal Req'd Recd TRACKING 07 PERMIT FEES 3 Plan Sets Plan Check submitted JsItem Aworal Structural Cales. True Calcs Enemy Cates. Reviewed, read• for corrections Called Contact Persont'I Plans picked up t 01 I / o Plan Check DepositLan Plan Check Balance Construction Flood plain plan Plans resubmitted 0Y Mechanical Grading plan 2" Review•, readyfo eorrectio srissue W Electrical Q. Subcontactor List Called Contact Pers Z lr Plumbing S.M.I. Grading G Grant Deed Plans picked up V-36705- H.O.A. Approval Plans resubmitted < ✓� I` -A(1. 46 oS IN HOUSE:- '" Review, ready fororrectioa snc 31� Developer Impact Fee Planning Approval CaUtd Contact Person 21 A.I.P.P. Pub' R'ks Appy Date of permit issue \ School Fees TotalP F Permit as AW /i a-> -)(1,3 6xacYt 04L� ove1