11-0164 (RC)P.O. BOX r'1504 •
78-495 CALLE TAMPICO
,y
LA QUINTA, CALIFORNIA 92253.
Application Number 11-00000164
Property Address: 56144 PGA BLVD
APN: 775-370-013-C -29421 -
Application description: REMODEL - COMMERCIAL
Property Zoning: LOW DENSITY RESIDENTIAL
Application valuation: 2000
Applicant: Architect or Engineer:
LCNT�JAtstW2 dill
LICENSED CONTRACTOR'S DECLARATION
l
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
I hereby affirrii,under penalty of perjury that I m lice urider provisions of Chapter 9 (commencing with
Section 7 0011//of Division 3 of the'Bu s nd P io aIs Code, and my License is in full force and.effect.
License C assl'B license No.: 84857
Y:
Date" Contractor:
'OWNER -BUILDER, DECLARATION -
I hereby affirm under•penalty of perjury that I am exempt from: the Contractor's State1icense Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county -that requires apermit 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 orshe is licensed pursuant to the provisions of the Contractor's State
License --Law (Chapter,.9 Icommencing .with:Section 7000) of Divisi`` nh.lof,theBusiness:antl 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-iis owner of the property; or my employees with' wages as their sole compensation, wrll-dp the work,-and
the structure is not intended or offered for'sale (Sec. 7044,. Business andProfessions Code: The
Contractors' State License Law does not apply.to-an ownecof property who builds or improves thereon,
and ,who'doesthe work himself or herselfthrough his'oi 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,Ae owner-builderwillhave 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'-Stafe.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.). -
(_) 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 aconstruction 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
Owner:
KSL DESERT RESORTS INC
56140 PGA BLV
LA QUINTA, CA 92253
Contractor:
EDWARDS CONSTRUCTION INC,
51455. DESERT CLUB DRIVE
LA-.QUINTA, CA 92253
(760)77.7-8202
Lic: No.: 684857
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 2/15/11
FEB 1 6.10:11
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the.following declarations: , "
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 whichthis permit is
issuedt
_ I have and will maintain workers' compensation insurance, asre'qu'iredby 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.numberare:
Carrier GRANITE STATE Policy'Numtier, WC1914223
'I certify that, in the performance of the work for.which this permit is issued, I shall not employ any„
person'in any man as b o Nect to the workers' compensation.laws of .California,
and agree that, ifshou b co s j ct the workers' compensation provisions of Section
,(3700 of the Labor'
'Cc --I t'al orthwit nply with those 'p visions:
Data l Applicant:> t
WARNING: 'FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO'CRIMINAL PENALTIES AND CIVICFINES 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
conditionsand 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 Ouinta, its officers, agents and employees for any act or omission related to the work being
.p performed under or following issuance of this permit.
2. Any permit issued as a result of thisapplication'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 certiJnd
t I ave read this application and state that the a oMos correct. I agree to comply with all
cityau y ordinances and state laws relating to buildi c hereby authori representatives
ofthint tlol enter upon the above-mentioned prope forses.
Date: . " Signature (Applicant or Agent):
„
Application Number 11-00000164
------ Structure Information REPAIR OF DAMAGE AT EXIT TRELLIS COVER -----
Other struct info . . . . . CODE EDITION
2010
FIRE SPRINKLERS
NO
MIXED-USE OCCUPANCY
B
OCCUPANT LOAD
2.00
1ST FLOOR SQUARE -FOOTAGE
.00
2ND FLOOR SQUARE FOOTAGE
----------------------------------------------------------------------------
.00
Permit . . . BUILDING PERMIT
. Additional -desc ,.,-.. . .
Permit Fee 45.00 Plan Check Fee
29.25
Issue_ Date Valuation,., .. .
. . 2000.
Expiration Date 8/14/11
Qty: Unit Charge. Per
Extension'
BASE PE81
15.00
15.00 2..0000 HND BLDG 501-2,000
30.00
'`Special Notes and Comments
:REPAIR OF DAMAGE AT -:EXIT TRELLIS -COVER
ONLY, REPLACE BROKEN 6X "BEAMS,> (2)
`) ABOVE*
ACROSS DRIVE' AISLE AND .(2) E
PILPSTERS;� AND:- PATCH STUCCO AT PILASTER
COLUMNS:`AND. GATEHOUSE. ALL' MATERIALS
AND, CONSTRUCTION TO,:MATCH'-EXI-STING.-
2010;.•CALIFOR•NIA ;BUILDING CODES.,.'
February. 15 ,' 2 01,1 -2.12 : 56'.. PM AORTEGA
----------------------
-------------------------------------------- -
--------------------------------------------- 7
Other Fees.:. BLDG STDS ADMIN (SB1473)
Other
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total. 45.00 .00 .00
45.0.0
Plan Check Total 29.25 .00 ..00
29.25..
Other Fee Total 1.00 .00 00
1.00
'Grand`Total 75.25. .00 .00
75..25
LQPERMIT
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Bin #
Cjtye:.Of iq -Qtdhia
• Building8t Safetq�Division
P.O. Box 1504, 78-495 Calle Tam PICO
La Quetta; CX 92253 - (760) 777-7012.
Building POrmit Application and Tracking Sheet
Permit #
Project Address: S6 ^ FWD •
Owner's Name:
A. P. Number:
Address:
Legal Description:
: City, ST, Zip
Contractor:
Telephone:
Address:
Project Description:
City, ST, Zip:
UE
7 � Zk?�
X.Telephone:
.11 >'•: :,;;;,:.;.:s:< .<.:>:•.^.;s:::,4 :r
State Lic. # I I
'City Lic. #:
•Arm +ngf-, Designer: .
Address:
City., ST, Zip:
4' •
Telephone:
State Lic. #
:vY �':�bij2{n::}+:ii:<v ):�'}`�`:ii:?r}?J�SM:�4::3�vj:
••{}.}�l•:
a rx" ::>. ••x: • :<:>?::#:<.'s';>; :.....
'ry�SL
-
'Construction Type: Occupancy:
- .
Project type circle one): New Add'n Alter Repair Demo
; Sq. Ft:: # Stories: # Units:
Name of Contact Person:
Telephone # of Contact Person: ���C
Estimated VaIue;of Project:
APPLICANT:.DO NOT WRITE BELOIN-THIS•UNE
#
Submittal
-Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets,
Plan Check submitted .:
/o
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
'Plans picked up
Construction
Flood plain plan
Plans resubmitted .
Mechanical
Grading plan
2" Review, ready for correctionvissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
,Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, ready. forcoririection issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
is
i1 tom.
' 'IX
I
CN
AS&
i1 tom.
' 'IX
I
CN
_ �.,.�w,..�y
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