09-0002 (TT)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:09--A-0000002
Property Address: 78130 CALLE TAMPICO
APN: 770-020-012- -
Application description: TEMPORARY TRAILER
Property Zoning: VILLAGE COMMERCIAL
Application valuation: . 1200
Tiht 4 4 Qgum
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Applicant: Architect or Engineer:
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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 Business and Professi als Code, and my License is in full force and effect.
License Class: B e o.: 397892
Date:—s'O ! ractor:
OWNER.. DECLARATION
1 hereby affirm unpens of perjury at 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 -
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
Owner:
HIGHLAND LA QUINTA II LLC
80 S LAKE AVE STE 660
PASADENA, CA 91101
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 1/05/09
Contractor: . ,,,, '-q/
MOOREFIELD CONSTRU IO INC. 11
600 N. TUSTIN AVENM5,STEC11
SANTA ANA, CA 92705
(714) 972-0700 494.7�/f�_\ v
Lic. No.: 397892
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WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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
Iissued.
l 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 MAJESTIC INSURA I Policy Number C20070379102'
'I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
person in any manner so as to ;beome subje othe workers' compensation laws of California,
and agree that, i ould becos the wo 'compensation provisions of Section
3700 of th or Code, I s th co a isions.
XI ate: i �O pplicant: .
WARNING: FAILURE TO SE E RKE OMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYE O CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$100,00 IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 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 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 unty ordinances and ate laws relating to building constructi �Efld hereby authorize representatives
of t county to enter upoDAe above-mentioned property for in p n purposes.
o,0115ate: 1 � f O i gnature (Applicant or Agentl' -
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PROPOSED
ONE-STORMILOING
-SHOPS I -
TOTAL
6213 50.50. FT.
AM 9ei! •N'O
NOT INCLUDED
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FOR REFERENCE ONLY
Bin#
City of La Quinta
Building 8z Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Ok/
Project Address: 7,S -13o 64 LU-- 7—/4" Pi 6o
Owner's Name: MUbLAWO 0�06ufWUZ_
A. 1-1. Number:
Address: 00-5 411,149 444 I F.&coo
Legal Description:
City, ST, Zip: 0
q Hd I
Contractor: Mooy_*_72�
_F1 rF1,0
Jeleph
'12 " M I r $
Address: (/O� rg 6,::)0
Project Description: r_a=�p
City, ST, Zip: L%-
6 1S.. e.,- c 114
Telephone: -7 1 - 0 -7 0
State Lic. #:
City Lic. fi:
Arch., Engr., Designer: by r-L-4555
Address: 3 2—Jt
city, ST, zip: OHT'Z[LD /(-1 76-/
Telephone: 2_108
. . .f. . . . . . . .
Construction Type: Occupancy:
State Lic. #:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: a_Ucg_;
Sq. Ft.:
Y Stories:
# Units:
Telephone # of Contact Person: (S 10) '761 %6o 2-
Estimated Value of Project: Loz, ;2 o
.
APPLICANT: DO NOT WRITE BELOW THIS LINE
fi
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections/issue
Electrical
Subcontaclor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
II.O.A. Approval
Plans resubmitted
Grading
IN IIOUSE:-
Iteview, read), for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees