06-0690 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4ht 4 4a Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: 06-00000690 Owner:
Property Address: 80758 VIA PUERTA AZUL PUERTA AZUL PARTNERS
APN: 762-240-003-22 -300962- 17700 SW UPPER BOONES
Application description: STRUCTURES OTHER THAN BUILDINGS SUITE 100
Property Zoning: MEDIUM .DENSITY RES PORTLAND, OR 97224
Application valuation: 5800
Contractor:
Applicant: Architect or Engineer: ARTISTIC LANDSCAPE INC
78601 POMPEII CT
4LA' QUINTA, CA 92253
4- (760)360-1395
Lic. No.: 379421
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 Class: C27 A LicenseNo.: 379421
L
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am 4xempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Prof4ssions 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 70001 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 _ 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 _ 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
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153,
Date: 2/15/06
FERRY RD
i
FEB 212006
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 n Policy Number 01KR-0032-02
I certify that, in the performs of the work for which this permit i su , I shall not employ'any ►
person it any manners o become subjeItheor
orkers' mp sation laws of California,
and agree that, if I sh I ecoma subje trs' c pens tion provisions of Section
3700 of the Labor , I shall fo wi " coth prov' ions.
Dat Applicant,
WARNING: FAILURE TO SE RE 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 days will s ject
permit to cancellation.
I certify that I have read this application and state that the abo information is correct. agree to ply ith all
city and county ordinances and state laws relating to buildin nstruction, and here thorize a ese tatives
of thi9s/c/my to enter upon the above-mentioned property o inspection pur ores.
D✓at/E�g�ignature (Applicant or Agent):
Application Number . . . . 06-00000690
Permit . . . BUILDING PERMIT INV FEE
Qe
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
4.50
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 .
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.
----------------------------------------------------------------------------
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 61.65 .00 .00
61.65
Other Fee Total 5.27 .00 .00
5.27
Grand Total 264.92 .00 .00
264.92
LQPERMIT
Application Number . . . . . 06-00000690
LQPERMIT
Bin #
City of La nuinta
Building u Safety Division
.O. Box 1504, 78-495 Calle Tampico
Bu. Quinta, CA 92253 - (760) 777-7012
g Permit Application and Tracking Sheet
Permit #
l0
Project Address: &7" I r
Owner's Name: e
A. P. Number:
Address: '
0
Legal Description:
Contractor: A,
City, ST, Zip: QK�t Zv
Telephone:
Address: t .�
Project Description:
City, ST, Zip:
Telephone: 7bG
State Lic. #:(-2—'7
City Lic. #: 1m
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lic. #:
Name of Contact Person:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.:
#Stories:
#Units:
Telephone # of Contact Person: d �
�d -
Estimated Value of Project. tom-
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
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
G 7,6
Flood plain plan
Plans resubmitted
Mechanical •
Grading plan
2"" Review, ready for corrections/issue
Electrical If
dlvR�S
Subcontactor List
Called Contact Person
Plumbing 11,tot/
re r- 7j
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'`" Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person--- ��1- �LL
A.I.P.P.
Pub. Wks. Appr
Date of permit issue �
School Fees
1.., +..�
cr�F3
Total Permit Fees
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BUILDING & SAFETY DEPT.
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DATE: REVISED 11��
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