12-0319 (CGAR)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
12-00000319
45190 SEELEY DR
604-630-027- -
GARAGE - COMMERCIAL
TOURIST COMMERCIAL
31517
Tity/ 4 4a Q"
Architect or Engineer:
10\C1__1
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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*8,Ja'G
E13 CONTRACTOR'S DECLARATION
I hereby affirm under penalty olicensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of r slanals Code, and my License is in full force and effect.
License Class: $LicenseNo.: 678862
❑atQr _ContracWNER-BUILDER DECLARATION
I hereby affirm under penalty oexempt 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 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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_ I 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.).
Lender's Name:
Lender's Address:
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11 / 13 / 13
Owner:
LA QUINTA RETIREMENT RESIDENCE
9310 NE VANCOUVER MALL DRIVE
VANCOUVER, WA 98662
(503)586-7217
Contractor: M 4
�A\
COLSON & COLSON GENERAL CON'•ENOV
2260 MCGILCHRIST ST, SE
SALEM, OR 97302 42013
(503)586-7401
Lic. No.: 678862
CITY OF LA QUINTA
i FINANCE DEPT.
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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 AUSAU BUSINESS Policy Number WCKZ91448642013
_ I certify that, in the parfarma of the work for which this permit is issued, I shall not employ any
person in any manner so s o beo i subject to the workers' compensation laws of California,
and agree that, if I sho Ace act to the workers' compensation provisions of Section
f the Labor Co u, I all f t ith comply with those provisions.
Date:4VJJAoAppIicant;
WARNING: FAILURE TO SECURE WOR ERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINA PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION T THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, I EREST, 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 Quints, 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*16kinfo
cessation of work for 180 days will subject
permit to cancellation.
I certify that I have read this application and state thion is correct. I agree to comply with all
city and county ordinances and state laws relating ton, and hereby authorize representatives
of this cou ty t onter upon the above-mantioned pfn purposes.
Data- Signature IAppllcan, or Agent):
LQPERMIT
Application Number . . . . . 12-00000319
Structure Information
Construction Type . . . . . TYPE V, UNPROTECTED
Occupancy Type . . . . . GAR, CARPORT, SHED, AG
Other struct info . CODE EDITION 2010
FLOOD ZONE NO
GARAGE SQ FTG 1608.00
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Permit . . . CARPORT/GARAGE
Additional desc . .
Permit Fee 297.50 Plan Check Fee 193.38
Issue Date Valuation 31517
Expiration Date 5/12/14
Qty Unit Charge Per Extension
BASE FEE 252.00
7.00 6.5000 THOU BLDG 25,001-50,000 45.50
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Permit . . . ELECTRICAL-CARPORT/GARAGE
Additional desc . .
Permit Fee . . . . 47.16 Plan Check Fee 11.79
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 5/12/14
Qty Unit Charge Per Extension
BASE FEE 15.00
1608.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 32.16
Special NotesandComments ~
1608 SF VAN GARAGE W/ STORAGE. ARCHITECT
DANIEL ROACH C2282. 2010 CODES.2013
DIF.**PERMIT DOES NOT INCLUDE TEMPORARY
POWER, BLOCK WALLS, TRASH ENCLOSURE AND
SITE LIGHTING.**
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Other Fees . . . . ART IN PUBLIC PLACES-COM 157.59
BLDG STDS ADMIN (SB1473) 2.00
ENERGY REVIEW FEE 19.34
STRONG MOTION (SMI) - COM 6.62
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid
344.66 .00
205.17 175.00
185.55 .00
735.38 175.00
Credited Due
.00 344.66
.00 30.17
.00 185.55
.00 560.38
LQPERMIT
Application Number . . . . . 12-00000319
LQPGRMIT