09-0394 (ELEC) .cellit4 4 ath
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: 4/30/09
Application Number: 09-00000394 Owner:
Property Address: 79709 HIGHWAY 111 KOMAR INV
APN: 600 020 036 23 CORPORATE PLZ STE 247
Application description: ELECTRICAL NEWPORT BEACH, CA 92660
Property Zoning: COMMERCIAL PARK
Application valuation: 35000 D J�
Contractor: H -
Applicant: Architect or Engineer: WL BUTLER CONSI CI TOi31,� T
B MASON RH �((( 2009
IRVINE, CA 926 8
1`I ^IL1 (949)587-2200 CITYOFLAQuiNiq �^
I` Lic. •
No. : 3553 F�NaNCF?,,FPT
•
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
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
License Class: B License No.: 355353 for by Section 3700 of the Labor Code,for the performance of the work for which this permit is
-� ��_� issued.
41�y 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-euIL'OER 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 SEABRIGHT Policy Number BB1091955
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 of the Labor e,I sltsll fd with 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 C' �, •
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).: _-In: scant:
( ) 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 WORKERS'COMPENS ON COVERAGE 1S 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($100,000). 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 I,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 contractor(s)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 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 above information 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,an eby authorize representatives
of this . rrty to enter upon he above-mentioned prope ni inspeciior}.p.
Lender's Name: ' �ti__ T'S
•axe: � —
- nature(Applicant or Agent(: �. �
Lender's Address: 111
LQPERMIT
Application Number 09-00000394
Permit ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . 44.75 Plan Check Fee . . 11.19
Issue Date . . Valuation . . . . 0
Expiration Date . 10/27/09
Qty Unit Charge Per Extension
BASE FEE 15.00
15.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 11.25
1.00 18.5000 EA ELEC SVC <=600V/<=200A 18.50
Special Notes and Comments
INSTALL 200 AMP PEDESTAL TO POWER 15
LANDSCAPE & WALKWAY LIGHTS PER PLANNING
DEPT. REQUIREMENTS ADJ. TO SOUPLANTATION
Other Fees BLDG STDS ADMIN (SB1473) 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 44. 75 .00 . 00 44.75
Plan Check Total 11. 19 .00 . 00 11.19
Other Fee Total 2. 00 .00 .00 2 .00
Grand Total 57. 94 .00 . 00 57.94
LQPERMIT
Bin# City of La Quinta
Building 8T Safety Division
Permit# 5cAA
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253- (760) 777-7012
OQ Building Permit Application and Tracking Sheet
_
Project Address: �]9 i 06 Owner's Name: 1:!aAL.c , 4 -)1-\
A.P.Number: Address: 111 I-4- : Tlr'-l*
Legal Description: City,ST,Zip: r�s k 1 s1..)R 0 i VI I\ ' ti,!'
Contractor: ` %'•!"
t t:-1 Ct'rlS tu C o 1 Telephone: 4l `i +70 . ::::.:::....
Address: ?) ►#14,CA1 Project Description:
City,ST,Zip: T0iir3e - 11- Uca [t,,,-A 1J‘5 yc•c-' .k^,\v f�trnILJ '- 7 t-I=ts V
9-:::]-
Telephone: elAci_rjt6' 1 Lq ... /•;.
-AgIN: F Tu TovJ+=iz- �tku+26G;-\[' ktJ9 V4AI-k-rLoA-N{
State Lic.#: Z, h�K.3 City Lic.#: t0\214 0 trt}t-tkil "Vb •,art; N & tt+'.J Jti•_,i. w-A,Af'‘,.\e 0--
Arch.,Engr.,Designer: Qt;o{fkr51,14 �-Z kiLe_4``1,22fv( yt E tmc -;•1,c1-11"s (A+.-c i\vvlj tl 0,.-• .
Address: \\‘c 1tz- Yt\iL N'f I [� rl(..' �I'r VAc---A\•i.-
City.,ST,Zip: ,r Vv . VGA ec,,
! " "TelePhone: I0 zJ0C0 ` r ` = ; Construction Type: Occupancy:
State Lic.#: � , :>: `:'•, ``=?',;`
-,_-.,:.:T,:A; ;.�;_;�;;,, �.�;;;;,,;;:;: Project type(circle one): New Add'n Alter Repair Demo
k4.1i-4:, icy r
Name of Contact Person: [`C1. � 1IIQL [' k 4- Sq.Ft.: #Stories: #Units:
Telephone#of Contact i [6i— 'j -i 2-211 rx'�
Person: � �- � �,r,-tfj[,� Estimated Value of Project: $��5/L"�G�'t�.ov
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
Title 24 Calcs. Plans picked up Construction
' Flood plain plan Plans resubmitted Mechanical
Grading plan 2"d Review,ready for corrections/issue Electrical
Subcontactor List Called Contact Person Plumbing
•
Grant Deed Plans picked up S.M.I.
H.O.A.Approval Plans resubmitted Grading
IN HOUSE:- Jrd Review,ready for corrections/issue Developer Impact Fee
Planning Approval Called Contact Person A.I.P.P.
Pub.Wks.Appr Date of permit issue
School Fees
Total Permit Fees