09-0053 (SOTB)- I,
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
LApplI ation Number
09-00000053)
Property Address: "__44025.
JEFFERSON ST
APN:
604-521-005- - -
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
NEIGHBORHOOD COMMERCIAL
Application valuation:
6400
Applicant: /
�ac W
Archjt c or Engineer-
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ENSED
ngineer:
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
——----———---————--——-------————---—---———-----ENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury th t am licensed under provisions of Chapter 9 (commencing with -
Section 7000) of Division 3 of the Busine s d P fessionals de, and my License is in full force and effect.
icense Class: B c se No.: 407578
Datf— �O Contractor:
WNER-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).:
1 _ I 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 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:
LQPER1N4IT
Owner:
REGENCY MARINITA LA Q
36 EXECUTIVE PARK STE
IRVINE, CA 92614
(949)726-6028
VOICE (760) 777-7012
FAX (760) 777-7011
INS - IO•NS=(_7.6.0, –777-7153
U� /
Date: %21/09
TA
LL -1 1 2" 2009 IJ
Contractor:
MERCER CONSTRUCTION COMPANY
42690 RIO NEDO WAY, SUITE D
TEMECULA, CA 92590
(951)296-0111
Lic. No.: 407578
------------------
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.
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 STATE FUND Policy Number 7190000181
I certify.that, in the per ance of the work for which this permit is issued, I shall not employ any
person in any mann r s as to ecome subject tot a workers' compensation laws of California,
and agree that, if I oul bec e s ject to the rkers' compensation provisions of Section
,VOO of the Labor ode, 1 shai fort i c m y ith th se provisions.
at °�L t• �✓ ' "%Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND 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 his permit.
2. Any permit issued as a result of this ap ica 'on becomes null and void if work is not commenced
within 180 days from date of issuanc of s h permit, or cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state t at the bove informka
ract. I agree to comply with all
city and county ordinances and state laws relating t build' co stru tieby authorize representatives
of this county t mer u9on the above-mentioned p perryr in ect n 11
Dal! L� NSignature (Applicant or Agentl:
Application Number .
. . . . 09-00000053
Permit . . .
BUILDING PERMIT
Additional desc
32 LIGHT STANDARDS
Permit Fee . . . .
90.00 Plan Check
Fee
58.50
Issue Date
Valuation
6400
. . . .
Expiration Date
7/20/09
�.
Qty Unit Charge
Per
Extension
BASE FEE
45.00
5.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
45.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc. +
Permit Fee
39.00 Plan Check
Fee
9.75
Issue Date. .
Valuation
0
Expiration Date
7/20/09
Qty Unit Charge
Per
Extension
BASE FEE
15.00
32.00 .7500
=---------------------------------------------------------------------------
EA ELEC POLE LIGHT
24.00
Special Notes and Comments
SITE LIGHTING - 32 LIGHT.
STANDARDS W/
FDTN Q 18 FT HGT. APPROVED
PER ORIGINAL
APPROVED PLANS. 2007
CODES.
--------------------------------------------------
Other Fees . . .
- - -
. . . . BLDG STDS ADMIN (SB1473)
1.00
ENERGY REVIEW FEE
5.85
STRONG MOTION (SMI)
- COM
.50
Fee summary Charged
----------
Paid Credited
------------------------------
Due
-----------------
Permit Fee Total
129.00 .00
.00
129.00
Plan Check Total
68.25 .00
.00
68.25
Other Fee Total'
7.35 .00
.00
7.35
Grand Total
204.60 .00
.00
204.60
LQPEILIIIT
Bin r�'r
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
/
vov
Project Address: �y I -w.5 -Jr--rfjFgjaI.1.�
A. P. Number: -
Legal Description. A ace\A- .
Contractor: E
Address: y
q V� l p
Gity,ST, Zip: CUL ,. z 5 o
.A
Telephone:t' C 21 %Fz� ass .v
1 o - - o�
Owner'.sNamt:,,
N iia. VA 0Qj N'tA Ll to .
Address: 36 rxe� QI t p1,k Sv t T£ 100
City, ST, Zip: jg41N •'26,,I
„,
Telephone: 6 pZ„;
� n
Project Description: 5 - ¢ Vii.. cs r "
p U �� CSS,
Stale Lie. # :
City l,ic. �:.
,�j l'1'�
Arch., Engr., Designer: -j" Uv
Address:Fill22. 1G 1A
City, ST, Zip: I'P Jq L' LCi I
Telephone: 1 �,
-
State Lic. k J LJO-
/ f hC� fi3 6✓ % f
� �,� .� fx ��y•
Construction Type: v_ 0 Occupancy:
Project type (circle one): Ne.V Add'n 'Alter Repair Demo
Name of Contact Person: C 1 P:E r3
Sq. Ft.: lyStories:I
rr Units:
Telephone # of Contact Person: � q - 22 I G2, 9 3
..>QV1.
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
Re q'd
Reed
TRACKrING..
PERMIT FEES
Plan.Sets
Pian Cheek submitted.Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.Called
Contact Person
Plan Check Balance
Title 24 Calcs.
PInns ,picked. up.
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for correction ssue
Zl
Electrical
5ubcoutactor List
Called ContactPc.rson
1
Plumbing
Grant Deed
Plans picked up
N.O.A. Approval
Plans resubmitted
Grading
IN HOUSE!-
7rd Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called. Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
I
Teta) Permit Fees
ZV v