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08-1572 (RC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 08-00001572 78085 AVENIDA LA FONDA 770-122-003-7 -000000- REMODEL - COMMERCIAL VILLAGE COMMERCIAL 5000 T4ht 4.4 Q" Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT , LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. -_ License Class: B License No:: 874262 OWNER -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 ($500).: ( ) 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.). ( ) 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: LQPERDIIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/26/08 Owner: KEVEN FORTON 78-085 AVE. LA FONDA LA QUINTA, CA 92253 /J vSEp �- Contractor: �j'?0op ROSS CONSTRUCTIO INC, ll 51555 DESERT CLUB D T LA QUINTA, CA 92253 F Ito) (760)777-8200 �FPT A Lic. No.: 874262 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 EXEMPT ' Policy Number EXEMPT . _ 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 should become subject to the workers' compensation provisions of Section 3700 of the Labor CgUe, I shall forthwith comply with those provisions. Date: ` Applicanrs�� WARNING: FAILURE TO SECURE WORKERS' COMPENS TI�VERAGE 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 building construction, and hereby authorize representatives ofthis county to enter. .uno upon the above-mentioned property fipr inspectiori:ses DateY : Signature (Applicant or Agent): LQPERMIT Application Number . . . . . 08-00001572 Permit . . . . . . BUILDING PERMIT Additional desc . Permit Fee 72.00 Plan Check Fee 46.80 Issue Date . . . . Valuation . . 5000 Expiration Date 3/25/09 Qty Unit Charge Per Extension BASE FEE 45.00 3.00 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 27.00 Permit . . . ELEC-MISCELLANEOUS Additional desc . . Permit Fee 15.75 Plan Check Fee 3.94 Issue Date Valuation 0 Expiration Date 3/25/09 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 .75 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE FRENCH DOORS WITH SLIDER AND REPLACE EXT. LIGHT. ---------------------------------------------------------------------------- _ Other Fees . . . . . . . . . ENERGY REVIEW FEE 4.68 STRONG MOTION (SMI) - COM 1.05 Fee summary Charged ---------- Paid ,Credited ------------------------------ Due ----------------- Permit Fee Total 87.75 .00 .00 87.75 Plan Check Total, 50.74 .00 .00 50.74 Other Fee Total 5.73 .00 .00 5.73 Grand Total 144.22 .00 .00 144.22 LQPERMIT Bin # City of La Quinta Building & Safety Division Permit # P.O. Box 1504, 78-495 Calle Tampico I La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: ' S p t% 6 Owner's Name:) N �D A. P. Number: Address: Legal Description: City, ST, Zip: Contractor:�CZ 1�-OS� Telephone:oil Address: S1 955 Project Description:��— City, ST, Zip: r (�V C N s U De (L— Telephone: -7z-, L State Lic. # : City Lic. #: Arch., Engr., Designer.-I�et`�J 0 , ,( Address: �O G4 -S o (sz-4 r, City, ST, Zip : jLJ-C.�P�,ii''CS �Z�9 Telephone: (� ? V —� Construction Type: Occupancy: State Lic. #: G� Project type (circle one): New Add'n Alter Repai Demo Name of Contact Person: "g4 -r--> Sq. Ft.: # Stories: 1 # Units: Telephone # of Contact Person: —1 i ,3 &.—I—) # Submittal Plan Sets Structural Calcs. Truss Calcs. Energy Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed H.O.A. Approval IN HOUSE: - Planning Approval Pub. Wks. Appr School Fees � 9 Rl�s uls �G Estimated value of Project: 56 O L7 APPLICANT: DO NOT WRITE BELOW THIS LINE Recd TRACzICING PERMIT FEES Plan Check submitted r l Item Amount �-- Reviewed, readpfor corrections Plan Check Deposit Called Contact Person Plan Check Balance Plans picked up Construction Plans resubmitted Mechanical 2nd Review, ready for correctinsfissue 2 Electrical Called Contact Person Plumbing Plans picked up S.M.I. Plans resubmitted Grading ''d Review, ready for corrections/issue Developer Impact Fee Called Contact Person A.I.P.P. Date of permit issue Total Permit Fees Q