06-2810 (RC)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
T Date: 7/27/06
Application Number: 06-00002810 Owner:
Property Address:' 57390 VIA VISTA PUERTA AZUL PARTNERS
APN: 762-240-003-72 -300962- 17700 SW UPPER BOONES FERRY RD
Application description: REMODEL - COMMERCIAL SUITE 100• /A1
Property Zoning: MEDIUM DENSITY RES PORTLAND, OR 97224
Application valuation: 3000 c
Contractor: JUL 27 2006
Applicant: • Architect or Engineer:.. RIPARIAN ENVIRONMENTS
P.O. BOX- 13990 CITY OFI.AAIUINTA
PALM DESERT, CA 92255. Flld�►RICE®�
(760)398-9997 '
Lic. No.: 839,002
.. - - - - - - --- 77 - - - - a 'y �- - - - - - - - - - - - - --_ - - - - - --- - - - - - - - - - - - - - -•- - - - --- - - - - - - - - - - - - - - - . — - -.- — _
LICENSEDCONTRACTOR'S DECLARATION WORKER'S COMPENSATIONDECLARATION
I hereby affirm under penalty. oLperjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: -
Section 700011 of Division 3 of the Business and Professionals Code, and my License is in full force and effect._ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided r,
License Class: A B C8, 27, license No.: 839002 for by Section 3700 of.the Labor Code, for the performance of the work.for which this permit is
issued.
Date Contractor. _t_I have and will: maintain workers' compensation insurance, as required by Section 3700 of the Labor -
L—J Code, for the performance of the work for which'this permit is issued.. My workers' compensation
- OWNER -BUILDER DECLARATION' insurance, carrier and policy number are:
'1 hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the - Carrier STATE. FUND - Policy Number. 1769754-2006
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to - I "certify that, in the performance of the work for which this permit is issued, I shall not employ any
. construct; alter, improve, demolish; or repair any structure, prior to its issuance, also requires the applicant for the - person in any manner so as to become subject to the workers' compensation laws of California,
permit to file asigned statement that he orshe is licensed pursuant to the provisions of the Contractor's State . - and agree that, if,l should become subject to the workers' compensation provisions of Section
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the. Business and Professions Code) or3700 of the Labor Code, I shall forthwith comply with those provisions..
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section. 7031.5 by, 1 -
•any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500)>: Date: • 6� Applicant:/
I 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 WARNING: FAILURE TO SECURE W RKERS'COMPENSATION COVERAGE IS UNLAWFUL,•AND SHALL • "
Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the DOLLARS (5100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED. FOR IN -
improvements are not intended or offered for sale. If, however, the building or improvement is sold within, SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES".
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.). - APPLICANT ACKNOWLEDGEMENT -
I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT .Applicationisherebymade to the Director of Building and Safety for a permit subject to the
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of, conditions and restrictions set forth on this application.
• _, property who builds or improves thereon, and who contracts for the projects with a contractors) licensed - 1 . Each person upon whose behalf this application is made, each person at whose request and for - -
pursuant to the Contractors' State License Law.). - - whose benefit work is performed under'or pursuant to any permit issued as a result of this application; -
I 1 I am exempt under Sec. B.&P.C. for this reason 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:,
Date: Owner: - . 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
CONSTRUCTION LENDING. AGENCY permit to cancellation.
I hereby affirm under penalty of perjury that there is a construction lending -agency for the performance of the I certify that I have read this application and state that the aboveinformation is correct. I agree to comply with all
.. work for which this permit is issued (Sec. 3097, Civ. C.). city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned pro
y for inspection purposes. '
Lender's Name: / �"- ",.r ` —
` Date: Signat Applicant or Agent): "
Lender's Address: — �• -
LQPER\1IT
Application Number ..
. . . . 06-00002810
_ Permit
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . .
15.75 Plan Check Fee
3.94
Issue Date
Valuation
0
Expiration Date
1/23/07
Qty Unit Charge
Per
Extension
BASE FEE;
15.00
1.00 7500
----------------------------------------------------------------------------
PER ELEC DEVICE/FIXTURE 1ST 20
.75
Permit
PLUMBING
_ Additional desc .
Permit Fee
21•.00` Plan Check Fee,.
5.25 ;
Issue Date.
Valuation
0
Expiration Date .
1/23/07, 11
Qty Unit Charge
Per`.
Extension.
BASE FEE
15.00
1.00 6.0000
--EA ' .PLB FIXTURE
6.00`
'-=---=----=--=-------------- ------------- ------ ---- - --- - -- - -
Special Notes and Comments
- - - -----------
ELECTRICAL & PLUMBING
FOR.DRINKING:,
FOUNTAIN .
Fee summary Charged Paid Credited
Due
----------- - - - - ------
` Permit Fee Total
--.- - -----.------- ---- --------------
36.75 .00 '.00
36.75
Plan Check Total
9.19 .00 .00
9.19
Grand :Total
45.94: 0,0 - ; 00,
45.94
D
Bin #
City of La -Quints
Building '& Safety Division
P.O. Box 1504, 78-495 Calle Tampico .
La Quinta, CA 92253 -,(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
o6��8I0
Project Address:
{ vi`
Owner's Name , QkJ
A. P. Number:.
U�nrcr��. 7 �t"L:.��
Address:
Legal Description:
City, ST, Zip:
22v l� � U I 0r,
Contractor:VA n ��F
r
Telephone:.
Address: p �,�j.F l
Project Description:
.City, ST, Zip: � L11v . �t eJ`�� � (�
Yl��i � rJ-1r,,1 , .
Telephone: )60. �j Z� b 6 ,.
State Lic. # eLDaz. City Lic. #: .
Arch., Engr., Designer: ,
II.. ,, / � /
Re, - fat' A / .Y
Address:
City, ST, Zip:
Telephone:•
State Lic. #:
Name of Contact Person:
I n/Leni.,�
Construction Type: Occupancy:
Projeci type (circle one): New Add'n Alter Repair
Demo
'Sq. Ft.:..
#Stories:
#Units:
Telephone # of Contact Person: i
Estimated Value of Project:
!
APPLICANT: DO NOT, WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
n
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'
2nd Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
A��
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 " ,
A.LP.P.
Pub. Wks. Appr
Date of permit issue. i`
School Fees
+_
Total Permit Fees
45,
9y
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DRINIQNG FOUNTAIN
ON CONCRETE PAD
(SEE SPEC. SHEET
FOR DETAILS)
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FOR ONST CTION ..
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DEVELOPER: JOB SITE:
Puerta Azul Partners, LLC 57-390 Via Vista at Puerta A,
8905 SW Nimbus Ave., Suite 400 La Quinta, CA 92253
Beaverton, Oregon 97008 office 760.702.7215 fax 760.
office 503-670-9300 fax 503-670-9400
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