07-2525 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 07-00002525
Property Address: 79630 HIGHWAY 111
APN: 649-020-014-1 -31143 -
Application description: STRUCTURES OTHER THAN BUILDINGS
Property Zoning: REGIONAL COMMERCIAL _
Application valuation: 22800
Applicant: Architect or Engineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Businesjl and Professionals Code, and my License is in full force and effect.
License Class: B I .e _ kicense No.: A76259
Date' (�'2(0"0,Vontractor: i M rV V v�
OAR -BUILDER DECLARATION
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 (5500).:
(_ 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 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:
LQPEILNIIT
Owner:.
HIGHLAND LA QUINTA, LLC
1055 E. COLORADO BLVD. 45178
PASDENA, CA 91106
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/21/07
Contractor:
MAR VEST U -����--^^
423.35 WASHINGTON ST, ST F#4w
PALM DESERT, CA 922
(760)360-7061 p®F�
Lic. No.: 876299
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 STATE FUND Policy Number 1846155
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 shout become subject to the workers' compensation provisions of Section
3700 of the Labor Code, shall forthwith comply wi hose rovisions.
/Date: �Cpplicant:
WARNING: FAILURE TO SECURE WORKER MPENSATION 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 buil ing construction, and hereby authorize representatives
of�this county to enter upon the above-mentioned proper for inesp Ctiort purposes.
Date: 9U—.gnature (Applicant or Agent): .
Application Number 07-00002525
Permit . . . BUILDING PERMIT
Additional desc . . 12-25 HGT LIGHT STANDARDS
Permit Fee . . . . 234.00 Plan Check
Fee
152.10
Issue Date . . . . Valuation
. . .
. 22800
Expiration Date 3/19/08
' Qty Unit Charge Per
Extension
BASE FEE
45.00
21.00 9.0000 THOU. BLDG 2,001-25,000
-------------------------------------------------- =---------------=----------
189.00
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee 24.00 Plan Check
Fee
6.00
Issue Date . . . Valuation
. . .
. 0
Expiration Date 3/19/08
Qty Unit Charge Per
Extension
BASE FEE
15.00
12.00 .7500 EA ELEC POLE LIGHT
9.00
------------- ---------------------------------------------------------------
Special Notes and Comments
12 QTY, 25 FT HGT PARKING LOT LIGHT
STANDARDS W/ FOUNDATION Q DUNES II
RETAIL.CENTER, 2001 CBC, 2004 CEC, 2005
ENERGY CODES.' NOTE: LIGHT STANDARD POLE
.DESIGN & HEIGHT SHALL MATCH EXISTING-
;PHASE I EQUIPMENT.1
Other Fees . . . . . ENERGY REVIEW FEE
15.21
STRONG MOTION (SMI)
- COM
4.•78
Fee summary Charged Paid Credited
------------------------------
----------
Due
-----------------
Permit Fee Total 258.00 .00
.00
258.00
Plan Check Total 158.10 .00
.00
158.10
Other Fee Total 19.99 .00
.00
19.99
Grand Total 436.09 .00
.00
436.09
1
LQPERMIT
Bin #
A
City of La Quinta.
Building & Safety Division r
P.O. Box 1504, 78-495 Calle Tampico
La Quirita, CA 92253.- (760) 777-7012 t'
BuildiLng Permit Application and Tracking Sheet
g
Permit.#
i
Project Address: �0 2 " % G—�p7Q - �17 /�
A. P. Number:
Legal Descrilition: S�Lgs
Owner's Name: UQ
Address:
City, ST, Zip:
Contractor: V S�' �
Address:'47' F
Z ^ Z
Telephone:
Project Description:
City, ST, Zip1 O VV\S26- ?_2A
Telephone:.710o - 7 —3Z
Q� ►1 1.c7�
a�:z . r Z
State Lic. # : '
a-� City Lic. #: a,��(Q.
Construction Type:. Occupancy;
P cY= .
Arch., Engr.,Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Project iype (circle one): New . Add'n Alter Repair Demo .
Sg. FL: # Stories: # Units:
Estimated Value of Project:
Telephone # o Contact Person: "' "��
APPLICANT: DO NOT WRITE BELOW THIS UNE
TRACMG PERMIT FEES
# Submittal Req'd - Reed7Cheftck
Plan Se
Pbmitted
9
Item
Amount
Stractur 1 Calcs..
Rdy.for corrections
Plan Check Deposit
Truss Cs les.
Called Contact'Person
Plan Check Balance
Energy Cales..
Plans picked up
Constriction
Flood ph in plan..
Plans resubmitted
Mechanical
Grading, Ian2"
Review, ready for correctio ue `
1
Electrical
Subeont ctor List
Called Contact Person
21
Plumbing
Grant Deed.
Plans picked up
S.M.I.
II.O.A. A proval
Plans resubmitted
Grading
IN HOU E:-
''' Review, ready for corrections/issue
Developer Impact Fee
PlanningApproval
Called Contact Person
A.LP.P.
Pub.Wks.Appr
Date of per 'issue
School F
------------
Total Permit Fees
D
W4411 sAifl y
CITY OF LA QUINTA - PUBLIC WORKS DEPARTMENT GREEN SHEET
li V
PUBLIC WORKS CLEARANCE FOR RELEASE OF BUILDING PERMIT
Form updated & effective 11/17/2006
lG ounuin . & z:)aTety e artment direct) b Public Works.
Please DO NOT submit the Green Sheet (Public Works Clearance) Packet to the Public Works Department
until ALL requirements listed below are. complete. Incom
be plete applications or applications which cannot
pr�iocessed will be returned to applicant.
Date: S -Z, -.,,0-j Developer: Q ' LLL_
PArcraze-No.: �,1 Tract. Name � Qs Q . ` ,� v,,- Lot No. (s):Z 9
-�_
Address(s).: 9 t-10 4 --,a : r I
The following are the requirements for PublicWorks Clearance to authorize issuance of a budding er iJ ) ?, 3
from the Building & Safety Department:
CUSTOM HOMES: PROVIDE ITEMS #2 #3 #4 AND #5 BELOW
❖ TRACT HOMES:. PROVIDE ITEMS #1 #2 #3 #4 (AS APPLICABLE
YOW
❖' COMMERCIAL BUILDINGS/OTHER: PROVIDE ITEMS .#1 #2 #3 AN15Y#4 E?E9 /
WALLS:: PROVIDE ITEMS #7 BELOW
PUBLIC WORKS
•:•'�, SIGNS: PROVIDE ITEMS #8 BELOW'
1. 1, Attach Pad Elevation Certificates in compliance with the approved design elevation for building
pad (maximum allowable deviation of .+/- 0.1 foot). Pad Elevation Certificates must be current
(within 6 months -of current date). If a precise grading plan creates thepad for a
withhold green sheet submittal until a Pad Elevation Certificate can be provided. approval, please.
2. k Attach geotechnical certification of grading. plan compliance.
3. ,Attach recorded final map showing proposed building locations are legal lots.
4. 'Attach a completed < 1 acre per lot or infill project Fugitive Dust Control project information form,
PM 10 plan & agreement or provide alternative & valid City approved PM 10 plan set reference
number or hard copy plan. PM 10 plans for commercial & residential developments (beyond 1 lot)
are submitted separately with grading plans & are subject to additional requirements.
5. Attach an approved precise grading plan for the building location(s). AO flood zone developments
will require an approved flood plain development plan.
6. Attach an approved rough grading plan for the building location(s).
Attach wall plan &related approved grading.p �PR�_'»�+-�ze.�L 3 F�rs�'
8. Attach sign layout/plan &related precise grading/landscape plan.
A'(�lp Ct l�✓✓�'C.L ONU(V
I have reviewed and confirmed the requirements listed above as presented and fineprover�mse�s te767(.
be sufficiently complete for construction of the posed buildings/structures/walls/signs on the subject
lot(s). Pursuant findin a ab ve pr ct ay be released for building permit issuance.
Recommended by: Dated: 5 Z �-7
Public Works Distribution: (Green Sheet to Building & Safety counter
(_) Green Sheet to Community Development
Declined for approval for reason(s) as follow(s), please correct and resubmit:
City of La Quinta - PM 10 Project Information ( < 1 acre per Lot or Infill Project) Page 1 of
Form updated & effective 8/25/2005
Project Information
Project Contractor:
Project Phase
Project Phase
Project Name:
(Check One):
❑ Construction
Project Tract
Number:
❑ Demolition
Lot Number(s):
Anticipated Start Date:
Anticipated
Project Street
Completion:
Address:
Total acres in active
construction (< 1 acre
per Lot):
Project Contact
Please Note: Dust control is required 24 hours a day, 7 days a week,
Information
regardless of construction status. Person listed below is responsible
for dust control during business and non- business hours.
Name:
Title:
Company Name:
Mailing Address:
City:
State:
Zip Code:
Primary Telephone
Number:
Fax:
24 Hour
Access/Emergency
Phone:
Cell Phone:
..,PM 10 Certificate
Number:
❖ Expanded PM 10 plans for commercial and residential developments > 1 acre are required by
the City of La Quinta.