07-2716 (PC)P.O. B6X 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4'ht - 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 10/08/07
Application Number: 07-00002716 Owner:
Property Address: 79174 HIGHWAY 111 STE 101 FOURTH QUARTER PROPERTIES
APN: 4 649-820=999- - - 45 ANSLEY DR
Application description: PATIO COVER - COMMERCIAL NEWNAN, GA 30
Property Zoning: REGIONAL COMMERCIAL (760) 613-3783 tJ
Application valuation: 359 G
Contractor:
Applicant: Architect or Engineer: ORANCO CONS RU TICOC
/r nR
3190-D AIR R OOP DR ?oo,
COSTA MESA CA
(714)432-11 FINgN�QV�NT
Lic. No.: 359596 CEDFpT A
-
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LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I 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 ass: B License No.: 359596 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
�ate:tE% Contractor: _ _ 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
OWNER -BUIL ECLARATION 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 DELOS INS Policy Number 01DKRM1100032
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'l 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 sh II forth ith comply with those provisions.
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).: ate: 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 - WARNING: FAILURE TO SECURE WORKERS' COMPENSATIO OVERAGE 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 1$100,000). IN ADDITION TO THE.COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
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.)
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
pursuantto the Contractors' State License Law.).
(_ I 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
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 1 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 c struction, and hereby authorize representatives
of this county enter upon the above-mentioned property for i specti urposes.
Date: L40140 Signature (Applicant or Agent):
LQPERMIT
Application Number . . . . . 07-00002716
.Permit .. PATIO COVER PERMIT
Additional desc .
Permit Fee 15.00 Plan Check
Fee
9.75
Issue Date Valuation
. . .
. 359
Expiration Date 4/05/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
------------------------------ ---------------------------------------------
Special Notes and Comments
27SF ADDITION TO EXISTING PATIO COVER, .
PERMIT NUMBER: 07-1479, [CHIPOTLE]
TENANT IMPROVEMENT. THIS PERMIT DOES
NOT INCLUDE ANY MODIFICATION TO
ELECTRICAL. October 8, 2007 10:24:55 AM
AORTEGA
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--------------------------------
Other Fees STRONG MOTION (SMI)
- COM
.50
Fee summary Charged Paid Credited
---------------------------
Due
--------------------
Permit Fee Total 15.00 .00
----------
.00
15.00
Plan Check Total 9.75 .00
.00
9.75
Other Fee Total .50 .00'
.00
.50
Grand Total 25.25 .00
.00
25.25
Bin/ft
CI of
City 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
Permit #
-`
Project Address: -7 _ 11f Ftw. 11I LA Mul,,IIA
ti
A. P. Number:
Owner's Name: G dr
Address:
Legal Description:
City, ST; Zip:
Contractor.
p 4 �' _
Address: 3 D - % D/'T
Telephone: -. `-
Project Description:
City, ST, Zip:
Telephone:
Y � F
/
State Lic. # : City Lic. #:
Arch., Fagn, Designer:
Address:
City, ST, Zip:
Telephone: _
State Lic. #:
Name of Contact Person:
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 43
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
lb Z-
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked up
Construction
Flood plain -plan
Plans resubmitted
Mechanical
Grading plan
2"d Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
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
n
Total Permit Fees