The URL can be used to link to this page

05-1824 (PLBG)4 r f n P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: O=UOUO-�824�_ Property Address: 79305 HIGHWAY 111 STE 1 APN: 649-030-999-7 -30420 - Application description: PLUMBING Property Zoning: REGIONAL COMMERCIAL Application valuation: 5400 T4ht 4 4 Q" Applicant: Architect or Engineer: D p MAY 13 2005 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -LrrM"—f LA QUI" 1n BICE DEP'L LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Ch 9 (commencing with Section 7000) of Division 3 of the Business �p ss�ls Code, and m se is in full force and effect. License Class: - - - - - - - - - - i ee C/ OWNER -BUILDER DEMOATION I hereby affirm 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.). (_ 1 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 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 ISec. 3097, Civ. C.). Lender's Name: Lender's Address: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 5/13/05 Owner: STAMKO DEV CO C/O PROVIDENT FINANCIAL MGMT 10345 W OLYMPIC BLVD 2 FL LOS ANGELES., CA 90064 Contractor: JACOBSSON ENGINEERING CONSTR P.O. BOX 14430 PALM DESERT, CA 92255 WCC: STATE FUND Lic. No.: A -B ------------------ 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 number are: Carrier 157666103 10/01/06olicyNumber 650389 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any mariner so as to become subject to the workers' compensation laws of California, and agree that, if I should become ubject to the workWs. compensation provisions of Section ' 3700 of the Labor Co 0 I i those provisions. ate= ••-,- - 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 J DOLLARS 1$100,0001. 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 buildin ctio(p�{a ddshere authorize representatives of this county to enter upon the above-mentioned Drop f .i!// Application Number . . . . . 05-00001824 Permit . . . PLUMBING INV FEE Additional desc . Permit Fee. . . 54.00 Plan Check Fee 6.75 Issue Date . . . . Valuation 0 Expiration Date ... 11/09/05 Qty Unit Charge Per Extension BASE FEE 30.00 1.00 24.0000 EA . PLB INTERCEPTOR 24.00 ---------------------------------------------------------------------------- Special Notes and Comments GREASE INTERCEPTOR PER CVWD APPROVAL. INVESTIGATION FEE FOR WORK BEGUN WITHOUT PERMIT. Fee summary Charged Paid Credited ----------------- Due ------------------------------ Permit Fee Total 54.00 .00 ----------- .00 54.00 Plan Check Total 6.75 .00 .00 6.75 Grand Total 60.75 00 .00 60.75 r N N 3� eb: 14 lbUbb483bU MORAN AND ASSOC PA(aE; ;;:Q2/05 ,FILA VALLEY WATER DISTRICT . • ASSESSOR'S PARCEL NUMBER 15 AveDue 52 : { idcheUa;"Califorma 92236 '". (160) 398-2651 ICATION FOR WASTEWATER INTERCEPTOR/SEPARATOR APPROVAL T ANT: Submit this form with a copy of a SCALED plot plan (l" = 201 to t" = 4p' SCALE) dmwn to District spcoifiicadoos. A nomdundabio filing fee is required when the application is submitted. Chock must be made payable to the Coachclta VaNcy Water Dispict Approval of this application shall remain valid ftir a period not to exceed one (1) year tiom date of payment. Plan Check No. Agenj Contractor, Cottmct Pelson Address City State Zip Telayhoue 4,1._ 0 j 7 Owner Address City State zip Telephone O Jobc Address city zip 'i re) ).eget Descriptia. D j DBA 14. PLEASE COMPLETE THIS SECTION FOR REVIEW OF FOOD ESTABLISHMENTS NOTE: PLANS WILL NOT BE ACCEPTED UNLESS THIS APPLICATION IS COMPLETE AND THE PLAN CHECK FEE IS PAID. GENERAL CONSTRUCTION: Type of Construction: New Food Facility V Remodel of Existing Food Establishment Hous ofOpptiobSatin Capacity: ty�biteral External External Seating with Misters or Heaters liar with Food Service Bar Nonfood Saviee Water Softener Service: i Multisavice (mu.%Sblc) Single Service (disposable) OWNER/REPAESENTATIVE DECLARATION: I certify that I have reed the entire application arid state that 811 infOrmatiOt 130MUL i understand that the amount of ft paid is based on my declaration of information on this form and that incorrect information is ground, for decal of the submitted plass. I also understand that plans *ill be discarded if not picked up within sixty (60) days of approval or denial and that no inspection of my establishment will be conducted, or approval granted to.operate, until all proper inform ivquwtod hes been received and plans have bean approved and retumed. Si - Duu . 1:. : l!}� m,. M1'•� '.:1 1' .: f�al7i;;Z.1•�i�`'• [V?: ai r:t'i':\'t711101S J . UM 1 :mss i ❑ Sand/OU a Interceptor waived No, of Systems 1)yc of Systcm(e) No. Dwelling Units / Il Fixture Units Cj Grosse tat=cptor Existing ❑ lZ BCe=ot ❑ Addition ❑ Lim Trap ❑ Clarifier p Conned to Sower o'ZGbO cal. REMARKS: 22r 11 's applicatloa ia: (Approved ❑ Damned ❑ Conditional Approval* Fee S Check No. ltematks Date �� Initial CV•WD-921 05/06/2005 09:14_ 7605648350 .02/10/2005 13:1a. -760-775-7351 d . MORAN AND ASSOC MAXCYS GRILL PAGE 04/05 PAGE., 02-