06-2015 (SPIN)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
(V4'�t 4 - 44 Qum&
Application Number:
06-00002015
Property Address:
50680 EI,SENHOWER DR STE 102
APN:
773-370-029= - -
Application Description:
6L'ECIPLU LNSJ?EC'.L'.LUN
Property Zoning:
MEDIUM DENSITY RES
Application valuation:
10,0
Applicant: Architect or Engineer:
V
LICENSEAONTRACTOR'S DECLARATION
BUILDING & SAFF'ETY.DEPARTMEN'T
BUILDING PERMIT
!:hereby affirm under penalty of perjury that: I am need under provisions of Chapter'9 (commencing with
Section 7000) of Division3 of the BusirssSandfossionats C my License is in full force and effect.
License Class: B Lic No 863620
ate:.�� tractor:
l000l
OWNOMILDER DECLARATION
I hereby affirm under penalty of perjury that am exempt from the'Contractor's State Ucensekaw for the
following reasom(Sec. 7031.5, Business and Professions Code:. Any city or county that requires a permit to
construct, altar,.improve, demolish,.or repair any structure, prior to its issuance, also,requires the;applicant for the
permit to file asigned statement that he or she, is licensed pursuant to the provlsions 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 fon 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 1, as owner of the property, or my employees with wagesastheir sole,comperisation, will do the work, and
the structure is not intended or offered for sale (Sec. 70", 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 ihe.work,himself or herself through his or her own, employees, provided that the
improvements are,not intended or offered for sale' it, 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'centracts:for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec: , BAP.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 ofthe
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMff
Owner:
LANDAQ INC
55920 PGA
LA uu1N'1-A,
MAY 15 2006
4VD CITY of LA S
• --RIM1410CET
Contractor:
G COMPANIES CONSTRUCTION INC
1105 QUAIL STREET
NEWPORT BEACH, CA 92660
(949)955-3832
Lic. No..: 863620
-------------------
WORKER'S COMPENSATION DECLARATION
VOICE (760) 777-7012
FAX (760) 777-7011
I FAX
(760) 777-7153
Date: 5/15,/06
I hereby affirm under penaltyafLpedury one ofthe 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 pemlit is
issued.
have and will maintain workers' compensation'insurence, as required by Section 3700 of the Labor
Code, for etre performence.of.the work foe which this permit is issued. My workers"compensation.
insurancecarrier'and policy number, re:
Carrier CLARENDON NATL P Number 03KR0028427
I certify that, in the performance of work for which this permits issued, I shall not employ any
_ person imany manner so as to _ me subject to the, rkers' compansation laws of California,
Wand agree that; III should bac subject to t e w ar ' compensation provisions of Section
3700 oft bon C e, I sh forthwith co I i provisions.
ate: �� Aii pprica
:
WARNING: FAILURE TO SECU ORKERS' COMPENSATION COVERAGE 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 3708 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 workisperformed under or pursuant to any permit issued as a result of this application,
the owner, and d the -applicant, each agrees to, and shall defend, Indemnify and hold harmless the City
of La Quints, its officers, agents and employees for any actor 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 780 days°from.date of issuance of such permit, caseation of work work.,
0 ays will subject
permit to cancellation.
I certify that I have read this application end state that the above f matron is Coegree t comply with all
city s my ordinances and state laws relating to building c ction, and by uthoriz a ntativea
o rc�ounty to enter upon above-mentioned pro rty for ' ion pure
Data./r �� .gnsturs (Applicant or Agent):
J
Application Number . . . . . 06-00002015
Permit SPECIAL INSPECTION
Additional desc .
Permit Fee . . . . i00.00
Plan Check
Fee
.00
Issue Date . . .
Valuation
100
Expiration Date . . 11/11/06
Qty Unit Charge Per
Extension
BASE
FEE
ivv.vv
Special Notes and Comments
SPECIAL INSPECTION FOR CHANGE OF
USE,
"LA QUINTA INSURANCE SERVICES"
Fee summary Charged
Paid Credited,
Due
Permit Fee Total 100.00
00
.00
100.00
Plan Check Total .00
.00
.00
.00
Grand. Total 100.00
.00
.00
100.00
Bin #City
of La" Quinta
Building ex Safety Division
P.O. Box 1504, 78495. Cape Tampico
!a Quinta, CA 92253 - (7.60) 777-7012
Building Permit Application and Tracking Sheet
Permk #
Project Address: ] ..6130 E i &eAdvieIr (Z_
Owner's Name: LANDf }Q.
A P. Number: - --1 '� — " 0 �- rQti
Address: 5 20 (rA 5LVD
Legal Description:
Contractor:•�.
CA r� ��T i
Address://657J
City, ST, Zip:
Telephone: ' III "I � 'III
Project Description:
P
City, ST, Zip:
Telephone: Q ��
State Lie. # 771
Arch., Fxw-, Designer:
1- Cd. S . Lt)-UA-
►t)-UAAddress:
Address:
City, ST, Zip:
Construction Type: Occul,ancy:
Project,t)pe (circle one): New Add'n alter Repair Demo
Telephone;
State Lica#:
Name of Contact Person: L
Sq.,Ft.:
# Stories:
#Units:
Telephone # of Contact Person--- '%
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIMG .
Pl'sRMIT, FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Dep, wit
Truss Calcs.
Called ContactPerson
Plan Check Bali rice
Energy Calcs.
Plans,bicked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
V Review, ready for correctionstissue
Electrical
Sabcontactor.List -
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.XL
ILO -A. Approval'
Plansresubmitted
Grading
IN HOUSE:-
'"' Review,.ready for correcdons/issue
Developer Impa.:t'Fee
Planning Approval
Called Coatsct-Person
AXP.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fe I