05-4948 (CCOM)t` -
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
05 9.00_0_-49-4-8-
47647 CALEO BAY
643-200-004- -
CARPORT - COMMERCIAL
COMMUNITY COMMERCIAL
17237
T4tyl 4 4 Q"
Architect or Engineer:
pA
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT.
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury tha 1 am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Bu and Prof sion Is Code, and my License is in full force and effect.
License Class: A B CS C27 icense No.: 181805
�te: .i ntractor:
OWNER- ILDER 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 ($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 _ 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
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: I V•
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/29/05
Owner:
LA QUINTA MEDICAL PARTNERSHIP
5500 TRABUCO RD #100
IRVINE, CA 92620
Contractor:
DIFFENBAUGH INC, J D
6865 AIRPORT DRIVE
RIVERSIDE, CA 92504
(951)351-6865
Lic. No.: 181805
------------------
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 AMER CASUALTY Policy Number WC274965862
_ I certify that, in the performance of the work for which this permit is issued, I shall not employ any
person in any manner as to become subject to the workers' compensation laws of California,
and agree that, if I s u d b ome subj t to tworkers' compensation provisions of Section -
a 3700 of the Lab r od I all forth th co I with those prov' ions.
D�tE �O v icant:
WARNING: FAILURE TO SECURE WORKERS' COMPEN ION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN CIVIL FINES UP TO ONE HUNDRED THOUSAND
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 ab ve ' formationV
ree to comply with all
city and county ordinances and state laws relating to buildi c truction, arize representatives
of this county to,ennt�er upon the above-mentioned propert f r n pection pu
Xe- — -C._-7 gnr ature (Applicant or Agent):
/01
r
Application Number . . . . . 05-00004948
Permit . . . CARPORT/GARAGE
Additional desc .
Permit Fee . . . . 189.00 Plan Check Fee
122.85
Issue Date . . . . Valuation . . .
. 17237
Expiration Date 6/27/06
Qty Unit Charge Per
Extension
BASE FEE
45.00
' 16..00 9.0000 THOU BLDG 2,001-25,000
----------------------------------------------------------------------------
144.00
Permit. ELECTRICAL-CARPORT/GARAGE
Additional desc .
Permit Fee .. . . 16.50 Plan Check Fee
4.13
Issue Date Valuation.
0
Expiration Date 6/27/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
2.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
1.50
-------------------------- -------------------------------------------------
Special Notes and Comments
72FT. X 18FT. METAL CARPORT, TYPE B,
S3 OCC. TYPE VN CONSTRUCTION, 2001
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ART IN PUBLIC PLACES -COM
66.18
STRONG MOTION (SMI) - COM
3.61
Fee summary Charged Paid Credited
-------------------------------------
Due
--------------------
Permit Fee Total 205.50 .00 .00
205.50
Plan Check Total 126.98 .00 .00
126.98
Other Fee Total 69.79 .00 .00
69.79
Grand Total 402.27 .00 .00
402.27
LQPERMIT
I
^low : Ga.A Appao ✓�+! G�Lci%1 fy T, o& P�«..�' �'3Svow
Bin #
3 City of La Quinn
Building U Safety Division
` P•Q• Box. 1504, 78-495 Calle Tampico
i La Quinta, CA 922.53 -.(760) 777-7012
Building Permit Application and Tracking Sheet
Permit # jrf
Project Address: -4 - 447
Owner's Name:
Address:
A. P. Number:
Legal Description:
City, ST, Zip:
Contractor:
Address:
Telephone:
Project Description:
City, ST, Zip: ^
Telephone:
y,
State Lic. # :
CityLic. #:�
Arch., Engr., Designer:
Address:
M' .5 4,5 4zxi � /La-u:tU
City, ST, Zip:
Telephone:
State Lic. #:
y. dv .
Construction Type: Occupancy:
Project type (c rcle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACK NG •
PERMIT FEES
Plan Sets
Plan Check submitted
Item . Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans. picked up CID
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading, plan
2' Review, ready for correetions/issae
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 correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
c/ 0