10-1213 (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:
10-00001213---
78085 AVENIDA LA FONDA
770-122-003-7 -000000-
REMODEL - COMMERCIAL
VILLAGE COMMERCIAL
12000
Td4t. 4 4 Q"
Architect or Engineer:
plP
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
FORTUNE PROP
Contractor:
MORRIS CONSTRUCTION
51200 CALLE PALOMA
LA QUINTA, CA 92253
(760)272-9292
Lic. No.: 867583
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/08/10
NOV OSzo,oD,
LA §u_1-
CE DEPT.
-------------------------------------------------
-----------------------------------------------—
SED C TRACTOR'S DECLARATION
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury at am Ii n d provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Bus' a and Pr e ' nals ode, and my License is in full force and effect.
_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
Lice a Class: 13 ense No.: 867583
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
issued.
Date: ' ntractor:
_ 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
OWNER -BUILDER DECLARATION
insurance carrier and policy number are:
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
Carrier EX MPT Policy Num r •XEMPT
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to -
_Lcertify that, in the performan of the work f r w i h this permit is issued, I shall not employ any
construct, alter, improve, demolish, or repair any structure, prior to its -issuance, also requires the applicant for the
person in any manner so o becom su ec t workers' compensation laws of California,
SAO
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
and agree that, if d ecome su ec o orkers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
3 Op of the or C d I shall forth. i c ply with those provisions.
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
l(, �s ��
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars IS500).:
ate: ll ii pplicant:
1 _ 1 1, 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
WARNING: FAILURE TO SECURE ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
APPLICANT ACKNOWLEDGEMENT
1 _ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
conditions and restrictions set forth on this application.
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
1. Each person upon whose behalf this application is made, each person at whose request and for
'pursuant to the Contractors' State License Law.).
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
(_) I am exempt under Sec. , B.&P.C. for this reason
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
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:
LQPERMIT
of La Oumta, 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 omes null and void if work is not commenced
within 180 days from date of issuance of su p 'mit, or cess o work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state that th ab ve info ation is orrect. I agree to comply with all
city and county ordinances and state laws relating to bui in constr ction an hereby authorize representatives
oI t ' county to ente000r upon th ove-mentioned prope y vinspec s '
Date:
7-1-6 ' ature (Applicant or Agent):
Application Number . . . . 10-00001213
Permit . . . ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . . 22.50 Plan Check Fee
5.63
Issue Date . . . . Valuation . . .
. 0
Expiration Date 5/07/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
10.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
---------------------------------------------------------------------=------
7.50
Permit . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee . . . . 39.00 Plan Check Fee..
.00
Issue Date . . . . Valuation . . .
. 1625
Expiration Date 5/07/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
12.00 2.0000 HND BLDG 501-2,000
24.00
----------------------------------------------------------------------------
Special Notes and Comments
65 L.F. 6' PERIMETER WALL WITH 2 COLUMNS
AND 10 ELECTRICAL FIXTURES (LIGHTING ON
COLUMNS AND GROUND LIGHTING), CITY
STANDARD. 2007 CODES-
ODES_----------------------------------------------------------------------------
------------------------- : ----------------- 7 ----------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473)
Other
1.00
STRONG MOTION (SMI) - COM
.50
Fee summary Charged Paid Credited
----------------------------------------
Due
-----------------
Permit Fee Total 61.50 .00 .00
61.50
Plan Check Total 5.63 .00 .00'
5.63
Other Fee Total 1.50 .00 .00
1.50
Grand Total 68.63 .00 .00
68.63
PERMIT - ,
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
To: Greg Butler, Building & Safety Manager
From: Les Johnson, Director -Planning
Permit #:
a-
BUILDING & SAFETY DEPARTMENT
(760)777-7012
FAX (160) 777-70.11
To CDD: // ef - /O
Due Date:
Status:
.-Building, Flans Approval
(This is an approval to issue a Building Permit)
The Planning Department has reviewed the Building Plans ' for the following
project:
Description:,
Address or General Location:
Applicant Contact:.
The Planning Department finds that:
❑ ...these.Building Plans do not require Planning Department approval.
...these Building Plans are approved by the Planning Department.
❑ ...these Building. Plans require corrections. Please forward acopy of the
attached corrections to the applicant. When the corrections are made
please return them to the Planning Department for review.
Les Johnson, Director-Planni Date
Bin #
Permit # Z �g
Project Address: 78 O es—
A- P. Number:
City of -La Quints _
Building & Safety Otvfs w
P.O. Box 1504, 78495 Caffe Tampko
La Quinta, CA 92253 - (760) 777-7012
Building Permit APPlkcation and Tracking Sheet
TKO ci Owner's Name: 7iok w,4 SA.,A
Address: 7 b o Os LA11. La,%oi ebi
_ City• ST' zip:
Contractor: KOPef 17109.91-5..lwe-
Address: S/ LOO
City, ST. Zip: to 6&1',u CA
Telephone: 7 60
StftLic.#:
Arch., Bag., Dc4per
City, ST. Zip:
Telephone:
State U, -
Name
Name ofContact Petsoa:
Telephony # of Contact person:
d Submittal
Plan Sets
Structural ala.
Truss ala.
Tldc 24 Cala.
Flood plain plan
Grading pian
SubcontacWr Uat
Grant Deed,
H.O.A. Approval
IN HOUSE:-
Ptanning Approval
Pub. Wlka. Appr
School Fees
ProjectDmflptioon: !v S L• lt= �'o e Vn►'neN
f C h /y1.t�/fi✓ Gt7a .l S 1�xM.� �/
.w In
Reed 1
Pian Ch
Called (
Plan pi
Plans n
2" RM
Called 1
Plans pl
Plans n.a
,Reyl
Called
Date of
Titr►CMG
PERMIT FEES
xk submitted
item Amount
i, ready for corrections
Plan Check Deposit
ontact Person
Plan Check Balance.
iced up
construction
mbmitted
Mechanical
:w, ready for eorrectio"Assae
Electrical
*matt Person
Plumbing
eked sup
S.MJL
submitted
Grading
w, ready for corrections/issue
---------------------
Developer Impact Fee
:ontaet Person
A.LP.P.
permit issue
Total Permit Fees
CITY OF LA QUINTA SUB -CONTRACTOR, LIST _
OB ADDRESS �$��� �"�'�� PERMIT NUMBER _OWNER _ BUILDER opc v A40
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance•
of building permit. For each applicable trade, all information requested below must be completed by applicant. "un File" is not an acceptable response.
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