12-0287 (SOTB)4V Qaft
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
Date:. 3/23/12
Application Number: r12-00000287- Owner:
Property Address: tt 79625 VISTA I.CORALINA LN LA QUINTA HOUSING AUTHORITY
APN: 600-020-054- - - 78495 CALLE TAMPICO
Application description: STRUCTURES OTHER THAN BUILDINGS LA QUINTA, CA 92253
Property Zoning: COMMERCIAL PARK.
Application valuation: 50000
Contractor:
Applicant: Architect or Engineer: OPTIMUS CONSTRUCTION INC
440 WESTERN AVE #202 Q
' LA QUINTA,.CA 92253 t`
(808)550-8411
Lic. No.: 902939.
GITyOF c,gy�VWT"A
----------------------------------- --------------------------------------------T':'�.'r----—---
- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSA7 -
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with - I hereby affirm under penalty of perjury one of the following declarations:
section 7000) 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 -
L' nse Class: B License No.: 902939 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is
_I¢� �1 issued.
�' Date: J ntractor: _ 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
OWNER-BUILDER DECLARATION - insurance carrier and policy number are: ,
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the _ Carrier STATE FUND Policy Number 0000506-2010
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 a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that; if I 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) or 3700 ofP& Labor de, 1 sh 11 fort ith 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 - -
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: Dater Applicant: -
1 _ 1 1, 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 WORKER ' 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 1$100,0001. 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 -
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made 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 contractorls) 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,
1 — 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 1 have read this application and state that the above information is correci. 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 buildi construction, and hereby authorize representatives
of is county to enter pon the above-mentioned prope r i pection purposes. ti
Lender's Name:
Date?L�kignature (Applicant or Agent):
Lender's Address:
LQPERMIT
LQPERMIT
Application Number . . . . . 12-00000287
Permit BUILDING PERMIT
Additional desc .
Permit Fee 414.50 Plan Check
Fee
269.43.
Issue Date Valuation
50000
Expiration Date 9/19/12
Qty Unit Charge- Per
Extension
BASE FEE
252.00
25.00 6.5000 THOU BLDG 25,001-50,000
162.50
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Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee 69.75 Plan Check
-Fee
17.44
Issue Date . . . . Valuation
0
Expiration Date 9/19/12
Qty Unit`Charge Per
Extension
BASE FEE
15.00
- 73.00 .7500 EA ELEC POLE LIGHT
54.75
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Special Notes, and Comments
SITE LIGHTING.173 LIGHT STANDARD POLES
W/_ENGINEERED FOUNDATION. 2010 CODES.
-------------------------------------------------------
Other Fees BLDG STDS ADMIN'(SB1473)
--
2.00
ENERGY REVIEW FEE
26.94
STRONG MOTION, (SMI)
- RES
5.00
Fee summary Charged Paid Credited
Due
Permit 'Fee Total 484.25 00
.00
484.25
Plan Check Total 286.87 .00
•.00
2.86.87,
Other Fee Total' 33.94 .00.
.00
33.94
Grand Total. 805.06 :00
.00
805:06
LQPERMIT