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06-2799 (TT)P.O. BOX 150-4 78-495 CALLE TAMPICO LA QUINTA,. CALIFORNIA 92253 Application Number: i 06-00002799 Property Address: i 46800 WASHINGTON ST APN: 643-020-999-2 -30903 - Application description: TEMPORARY TRAILER Property Zoning: REGIONAL COMMERCIAL Application valuation: 3000 Applicant: Architect or Engineer: LICENSED CONT! I hereby affirm under penalty of perjury that I am licensed der Section 7000) of Division 3 of th ass and. Prof canals • B BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: WASHINGTON 111 LTD C/O JACK TARR 30240 RANCHO VIEJO RD. STE. B SAN JUAN CAPISTRANO, CA 92675 Contractor: W L BUTLER CONSTRUCTION, INC. 7 GOODYEAR IRVINE, CA 92618 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Dater 7/26/06 JUL 2006 l (949) 587-2206 CITY OFer.Qij, ii1k l LiC. No.: 355353 FINANCE DEQ DECLARATION. - WORKER'S COMPENSATION DECLARATION n Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: my L� nse is in full force and effect. _ - _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License lass. L en - rvo.: 355. 53 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is D^� �1 �s issued. tel f� on vJ.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 OWN LD R DECLARATION - - insurance carrier and policy number are: 'I hereby affirm under penalty of. perjury than am ex pt fro he Contractor's State License Law for the Carrier ABD INS Policy Number C12012701 ' following reason (Sec. 7031 .5, Business and Profe sions Cod "Any city or county that requires a permit to _ I certify that, in the performance of the work for w, -KY c this permit is issued, I shall not employ any " construct, alter, improve, demolish, or repair any ructure, pri r its issuance, also requires the applicant for the person in any manner so as to becorrie- to �workers' compensation laws of California, permit to file a signed statement that he or she ' licensed purs ant o the provisions of the Contractor's State and agree that, if I should bec a sub, o t rs' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Di 'sio of the Business and Professions Code) or �� 13700 of the'Labyr. Code, I shall f ith co I those provisions. that he or she is exempt therefrom and the basis for the alleged m ion. Any violation of Section 7031.5 by. any applicant for a permit subjects the applicant to a civil penalty o 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 i/ 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, 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 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:1. ' Lender's Name: _ Lender's Address: LQPERMIT WARNING: FAfgURE TO SECURE WORKERS' COMP SA ON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT. AN EMPLOYER TO CRIMINAL PENALTIE AND IL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE.CO OFC ENSATION, DAMAGES AS PROVIDED FOR IN - SECTION 3706 OF THE LABOR CODE, INTERES , AND A TO EY'S FEES - APPLICANTA oildin LEDGEMENT IMPORTANT Application is herebymade to the Director of 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 ofthis 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 rk is not commenced .. within 180 days from date of issuance of such permit, or cessation ork for 180 days will subject permit to cancellation. I certify that I have read this application and stateghat the above.informa ' is «ect. agree to comply with all city and county ordinances and state laws relatinuildin nstr on, an h eb uthorize representatives is.of thc my tq enter upon the„above-mentionederty for ' _ tion pu ose Application Number 06-00002799 Permit . . . TEMP TRAILER / MOBILE HOME Additional desc . Permit Fee 200.00 Plan Check Fee .00 Issue Date Valuation 3000 Expiration Date 1/22/07 Qty Unit Charge Per Extension BASE FEE 200.00 Special Notes and Comments TEMP CONSTRUCTION TRAILER PER MUP # 06-647 Fee summary Charged Paid Credited Due Permit,Fee Total 200.00 .00 .?01. 200.00 Plan Check Total .00 .00 00 .00 Grand Total 200.00 _ .00 .00 200.00• Bin # City of La Quinta Building u Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # /n} 0` Project Address: 96o S Owner's Name: A. P. Number:. Address: v D-LfoV; en -l) L' J Legal Description: City, ST, Zip: Sucdvm Contractor: p e ;N Tele hone: ©_2 Project Description: Address: City, ST, Zip: —� �p� rw QQ.S PSL Cit-..��-'La-1 Telephone-"' 6i —D '7 35'Zo #0; `� f State Lic. # : 35 City Lic. #: Arch., Eng., Designer: Address: City, ST, Zip: Telephone: a ' , Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: * 3voo 'f APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called'Contact Person Plan Check Balance Energy Calcs. Plans picked up . Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready for correctionsrssue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading W HOUSE:- 3'd Review, ready for corrections/issue _ Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees a?. 20D MA 1 O z OL 211S N X19 N I H SVM �