06-0691 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
TW�l 4 4 Qum&
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
06-00000691
80752 VIA PUERTA AZUL
762-240-003-23 -300962-
STRUCTURES OTHER THAN BUILDINGS
MEDIUM DENSITY RES
5800
I hereby affirm under penalty of perjury
Section 7000) of Division 3 of the Busi
License Class: C27
Date d Contra
Architect or Engineer:
LICENSED CONTRACTOR'S DECLARATION
at am licensed under provisions of Chapter 9 ommencing with
and Professionals C�ype, and my L}e�nse is full force and effect.
J Lic6(se No.: 3179'421
S c'k- f
OWNER -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, 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.).
(_) 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
Date: 2/15/06
Owner:
PUERTA AZUL PA
17700 SW UPPER
SUITE 100
PORTLAND, OR 9,
U
Contractor: FEB 21 1006
ARTISTIC LAN CAPE IWOF�,gGUINT
78601 POMPEII C �NANCEpE� A
LA QUINTA, CA 92253
(760)360-1395
Lic. No.: 379421
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.
�( 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
insurance carrier and policy number are:
Carrier CLARENDON INS Policy Number 01KR-0032-022
I certify that, in the performance of the work for which this permit ' i su , I shall not employ any
person in any manner so as become subject to th orkers' co p sation laws of California,
and agree that, if I shout come subject the w r ers' c ns ion provisions of Section
3700 of the Labor Co , shall forth 't omply ' h tho a ovi ons.
Dati%L�G�PPlicafit:
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 ($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 d s w' subject
permit to cancellation.
1 certify that I have read this application and state that the a e information /hereth
gre t co ly with all
city and county ordinances and state laws relating to buil ' construction, na repr entatives
of this cou ty to enter upon the above-mentioned prop rinspect rp
Date i/ ignature (Applicant or Agent
Application Number . . 06-00000691
Permit . . . BUILDING PERMIT INV FEE
Additional desc . .
Permit Fee . . . . 162.00 Plan Check Fee
52.65
Issue Date . . . . Valuation . . .
. 5800
Expiration Date 8/14/06
Qty Unit Charge Per
Extension
BASE FEE
90.00
4.00 18.0000 THOU. BLDG 2,001-25,000
----------------------------------------------------------------------------
72.00
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee 18.00 Plan Check Fee
3.75
Issue Date Valuation . . .
. 0
Expiration Date 8/14/06
<
Qty Unit Charge Per
Extension
BASE FEE
15.00
4.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
----------------------------------------------------------------------------
3.00
Permit . . . PLUMBING
Additional desc . .
I
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . .
. 0
Expiration Date 8/14/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4.OUTLETS
3.00
----------------------- ----------------------------------------------------
Special Notes and Comments
BARBEQUE ONLY. INVESTIGATION FEE
ASSESSED PER 1997 UNIFORM
ADMINISTRATIVE CODE $304.5 FOR WORK
BEGUN WITHOUT BUILDING PERMIT.,
r----------------------------------------------------------------------------
Other Fees . . ... . . . . . ENERGY REVIEW FEE
5.27
Fee summary Charged Paid Credited
-----------------
Due
----------------------------------------
Permit Fee Total 198.00 .00 .00
198.00
Plan Check Total 60.90 .00 .00
60.90
Other Fee Total 5.27 .00 .00
5.27
Grand Total 264.17 .00 .00
264.17
LQPERMIT
Application Number . . . . . 06700000691
LQPERMIT
Bin #
'0 City �C
i Ci of La (�uinta
' Building 8z Safety Division
0J,9 .O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Ilding Permit Application and Tracking Sheet
Permit #
9/7,
Project Address:
Owner's Name:
A. P. Number: -7 ,
ddress: To
Legal Description:
Contractor: I L i✓
City, ST, Zip: Q Z�
Telephone:
Address:v t
Project Description:
City, ST, Zip: t��Z
�� /C<7`i1•
Telephone: 2 �-C, c 1
State Lic. 4:C2—'7 City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
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 Proje . 6 �'
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACHING
PERMIT FEES
Plan Sets
Plan Check submitted
-/2/03
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
50 r8
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for corrections/issue
Electrical
fdlLaS
Subcontactor List
Called Contact Person
Plumbing& gAS..�/
aOT/BT'f
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted^^
Grading
IN HOUSE:-
'"' Review, ready r coreconshssu
Developer Impact Fee
Planning Approval
Called nta t qqe \ Yn A �� -
F. -`d.-- .. 1 Q
A.LP.P.
Pub. Wks. Appr
Da C f e m t is ae'\
School Fees
Total Permit Fees
.. JIW � -- - - - __�__ . _.�.--,�.- -_ _ _ _ __ _ _