10-1355 (SOTB)t
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
B ILDING PERMIT ;
Date: 12/13/10
Application Number: 10-00001355 Owner:
Property Address: 79125 HIGHWAY Ill FGS
y; LATORRE ROBERT N
APN: 649-030-078-2 -28525 - �) C/O TOM KELLY
+Lf
Application description: STRUCTURES OTHER THAN BUI DI 83368 HIGHWAY 111
Property Zoning: REGIONAL COMMERCIALC INDIO, CA 92201
Application valuation: 1000 w
Q L1
Contractor:
Applicant: Architect or En neer ADOBE ELECTRIC
68805 PEREZ ROAD STE G-70
`' CATHEDRAL CITY, CA 92234
(760)202-0300
Lic."No.: 794758
r
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lice ed unde ovisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Pro sional de, and my License is in full force and effect.
License%Cla s: C10 enseNo.: 794758
Date: / " �� Contra
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 1$500).:
(_) 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 taw.).
(_) I am exempt under Sec. , BAP.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: -
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 EXEMPT Policy Number EXEMPT
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 subje o the w - ers' compensa[ion laws of California,
and agree that, if I should become subje the wor rs' compensation provisions of Section
/tWIApplicant:
of the Labor Code, I shal comply ,th those provisions.
KDate:t
WARNING: FAILURE TO SECURE WORK ERS','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 Ouinta, 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 BO days will subject
permit to cancellation. " .
I certify that I have read this application and state that the above information is corr agree to comply with all
city and county ordinances and state laws relating to building construction, h authorize representatives
of thisi nteter upon the above -mentioned property for inspectio r
�atI ` J Signature (Applicant or Agent):
LQPERMIT
Application Number . . . 10-00001355
Permit . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 25.00 Plan Check Fee
16.25
Issue Date . . . . Valuation . . .
. 10.00
Expiration'Date 6/11/11
Qty Unit Charge Per
Extension
BASE -.FEE
15.00
5.00 2.0000 HND BLDG.501-2,000
-------------------------- 7--------------------------------------------------
10.00
Permit . . . ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . . 19.50 Plan Check Fee
4.88
Issue Date Valuation
0
Expiration Date 6/11/11
Qty Unit Charge Per
Extension
BASE FEE
15.00
6.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
4.50
Special Notes and Comments
(3) 120V ELECTRICAL OUTLETS'AT SALES LOT
AND INTERIOR AND EXTERIOR OF SERVICE
DEPARTMENT WITH FUTURE 240V/40A VEHICLE
CHARGING STATION FOOTINGS, WIRING AND
CONDUITS. 200.7/2008 CALIFORNIA BUILDING
CODES.
December 13, 2010' 10:39:19 AM AORTEGA
----------------_------------------------------------------------------------
Other Fees . . . . . . . . .-BLDG.STDS.ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 44.50 .00 .00
44.50
Plan Check Total 21.13 .00 :00
21.13
Other Fee Total 1.00 .00 .00
1.00
Grand Total 66.63 .00 .00-
66.63
LQPERMIT
?VIC
rt
Bin #
City of La Quinta
Building 8r Safety Dlvtcion
P.O. Bog 1504, 78-495 Call- Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name:
A. P. Number:
Address:
Legal Description:
City, S.T. Zip:
Contractor: bo Be— &eae,.; lc_
Telephone:(760) 7 77 -P"
Address: k -rel' Ztj -00-6 70
Project Description:
City, ST, zip: Ci 2 z sy
3 - I• ZOVa+r- 0volee+ I „ Jer✓,u .
Telepho� (71,A) ,2,02 -030o
Statc Lic. # : cJe -74y xis City Lic. #;
Arch., Engr., Designer:
. f ,%* _ �" _ - 4 a -
t,»L
(3- 14 C9 T
Address:
City, ST, Zip:
Telephone:
Construction Type: Occupancy:
State Lit. #:
Name of Contact Person:
Project type (circle one): New Add'n Alter Repair Demo
Sq. FL:
#Stories:
# Units:
Telephone # of Contact Person:
Estimated Value of Project: /QUD
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACXNG
PERMTI. FEES
Plan Set
Plan Cheek submitted
Item Amount
Structural Cale.
Reviewed, ready for corrections
Plan Check Deposit
Pa+
Truss Cale.
Called Contact Person
Plan Check Balance
19tle 24 Cates.
Plans picked up
Construction 162; 2Sgo
Fl0od plain plan
Plans resubmitted
Mechanical r—
Grading plan
2'! Review, ready for correctionslissue
Electrical
Subeoutector List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S M.L
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
3" Review, ready for correctionstissue
Developer Impact Fee �
Planning Approval
Called Contact Person
A.LP.P.
Pub. Wks. Appr
Date of permit issue
no
School Fee
Total Permit Fees