05-3603 (RC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
BUFLDING PERMIT
Application Number:
•: 05-00003603
Property Address:
L-,-,78080 CALLE`E
APN:
770 -151 -003 -
Application description: REMODEL - COM + R IAAUG /+
2
Property Zoning:
VILLAGE COMME
I L f/1i lu7 ZUO�.
Application valuation:
1500
CITY OF LA QUINTA
FINANCE ®EPT.
Applicant:
Architect or Engineer:
sr
Lic. No.: -
---��°iD61-
--------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I 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 Classss::.: B ' 1 LicenseNo.: 7*ON
71883 p►��
Co or: It�v �^�+m
R- L R E RI hereby affirm under penalty of perjury t at I am xempt from the Contractse 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, 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 Cnntrantors' State License Law.).
1 _ 1 1 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:
LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
t
Date: 8/12/05.
Owner:
MARVIN WELLS L
78080 CALLE ESTADO STE 201
LA QUINTA, CA 92253
Contractor:
MARVIN INVESTMENTS, INC.
78015 MAIN ST STE 205
LA QUINTA, CA 92253
(760)771-2567
Lic. No.: 771883
------------------
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.
Jl I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor
i� 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 1440125-2065
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,
gree that, if I should become subject to the workers' compensation provisions of Section'
0 of the Labor , I shall forthwith co ly yvith those p o isions
ate: icant: W
WARNING: FAILURE TO SECU WORKERS' COMPENSATI 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 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 applica 'on and state that the above information is correct. I agree to comply with all
city and county ordinances and to laws relating to building construction, and hereby authorize representatives
of thi o/nu to r`rVa�upo a above-mentioned property for inspection purposes.
�a v �e egnature (Applicant or Agent): A
1
Application Number . . . . . 05-00003603
Permit . . . BUILDING PERMIT
Additional desc
"
Permit Fee . . . . 35.00 Plan Check
Fee
22.75
Issue Date . . . . Valuation
. . .
. 1500
Expiration Date 2/08/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
10.00 2.0000 HND BLDG 501-2,000
-----------------=------------------=---------------------------------------
20.00 .
Permit ELECT - ADD/ALT/REM
Additional desc .
Permit Fee, 24.00 Plan Check
Fee
6.00
Issue Date Valuation
. . .
. 0
Expiration Date 2/08/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
12.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
9.00
--------------------------------------------------------------
Special Notes and Comments
--------------
NEW DEMISING WALL TO SHELL (OLD
LIBRARY)CREATING SUITES 101 AND 102.
ELECTRICAL PERMIT INCLUDED. TYPE V -N
CONSTRUCTION, 2001 CODES.-
-----------------------'-----------------------------------------------------
Other Fees . . . . . . . . . HOURLY PLAN CHECK
35.00
Fee summary Charged Paid Credited
----------------- ---------- --- ------ ---------- ----------
Due
Permit Fee Total 59.00 .00
.00
59.00.
,Plan Check Total 28.75 .00
.00
28.75
Other Fee Total 35.00 .00
.00
35.00
Grand Total 122.75 .00
.00
122.75
LQPERMIT
b fa�gy RIVERSIDE COUNTY
t
��AA... �Pfl01EC7lOp� ''• � .� ' '
John R. Hawkins
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Beaumont
Calimesa
Canyon Lake
Coachella
.;
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
•A
La Quinta
Moreno Valley
Palm Desert
...
Penis
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jeff Stone,
District 3
Roy Wilson,
District 4
Marion Ashley,
District -5
FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
82675 Highway 111, Suite 2150 e Indio, California 92201-. (760) 863-8886 - Fax (760) .863-7072
Date `� k-1 C) 6 .
City Of La Quinta
Building Department
RE: DCC o pZ_'tJG�
The'Riverside County Fire_Department is granting the Fire clearance fouthe following
Location .1ko go CALL. F_ _ t;S i<�D0 L • Q _;Please call if you should
Any questions . 760-863-8886.
i
i
Respectfully
By
Traci Williams
Fire Systems Inspector
39493 Los Alamos Road, Suite A • Murrieta; California 92563 - (951) 600-6160 - Fax (951) 600-6164
4080 Lemon Sheet, 2nd Floor -.Riverside, California - (951) 95511777 - Fax (951) 95511886
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