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05-0257 (CSCS)46650 Adams Street Titit 4 //;; I (III II VIII III VIII (III 52 P.O. BOX 1504 W IE 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: 10/28/05 Application Number: 05-00000257Owner: Property Address: 46650 ADAMS ST FOURTH QUARTER PROPERTIES APN: 649-820-999- - - 45 ANSLEY DR Application description: NEW COMML - STORES & CUSTOMER SERVICE NEWNAN, GA 30263 Property Zoning: REGIONAL COMMERCIAL (760) 613-3783 Application valuation: 423626 D Contractor: Applicant: Architect or Engineer: VRATSINAS CONSTRUCTION OCT 2 8 2005 P.O. BOX 2558 LITTLE ROCK, AR 72203 CITY OF LAQUINTA (501) 376-0017 FINANCE DEPT. Lic. No.: --------------- Lic. No.: 572657 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Class: B License o.: 572657 ate: Contrac r. 0 NER- UILDER DECLARATION I hereby affirm under penalty o y 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 ($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.). (_) 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 Law.). ( ) 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: LQPEILVIIT 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. XI have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor l Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier ZURICH INS Policy Number WC531636300 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 subject to the workers' compensation laws of California, and agree that, if I should bec bject to the workers' compensation provisions of Section 3700 of the Labor Code al orthwith comply 1th th se provisions. D — Applicant: WARNING: FAILURE TO SECUR W0 ' COMPE SAT( N COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIM L 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 for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building co tion, and her uthorize representatives of this aunty enter upon the above-mentioned grope in pection purposes. c tY Date attSignature (Applicant or Agen+J Application'Number . . . . . 05-00000257 Permit BUILDING PERMIT Additional desc . . Permit Fee . . . . 1773.50 Plan Check Fee 1152.78 Issue Date . . . . Valuation . . . . 423625 Expiration Date . . 4/26/06 Qty Unit Charge Per Extension BASE FEE 639.50 324.00 ---------------------------------------------------------------------------- 3.5000 THOU BLDG 100,001-500,000 1134.00 Permit . . . ELEC-NEW COMMERCIAL Additional desc . . Permit Fee . . . . 181.80 Plan Check Fee 45.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 4/26/06 Qty Unit Charge Per Extension BASE FEE 15.00 8340.00 ---------------------------------------------------------------------------- .0200 ELEC GARAGE OR NON-RESIDENTIAL 166.80. Permit . . . GRADING PERMIT Additional desc . . Permit Fee . . . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . 0 Expiration Date 4/26/06 Qty Unit Charge Per Extension ---------------------------------------------------------------------------- BASE FEE 15.00 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 141.00 Plan Check Fee 35.25 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/26/06 Qty Unit Charge Per Extension BASE FEE 15.00 7.00 9.0000 EA MECH FURNACE <=100K 63.00 7.00 ---------------------------------------------------------------------------- 9.0.000 EA MECH B/C <=3HP/100K BTU 63.00 Permit . . . . . . PLUMBING Additional desc . . Permit Fee . . . . 36.00 Plan Check Fee 9.00 LQPERMIT f Application Number . . . . . 05-00000257 Permit PLUMBING Issue Date . . . . Valuation . . . . 0 Expiration Date . . 4/26/06 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 6.0000 EA PLB ROOF DRAIN 18.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 ---------------------------------------------------------------------------- Special Notes and Comments 8340 SQ. FT. SHELL BUILDING ONLY June 10, 2005 10:57:47 AM jjohnson ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ART IN PUBLIC PLACES -COM 2018.48 DIF CIVIC CENTER - COMM 788.50 ENERGY REVIEW FEE 111.64 DIF FIRE PROTECTION -COMM 265.60 STRONG MOTION (SMI) - COM 85.61 DIF STREET MAINT FAC -COMM 190.90 DIF TRANSPORTATION - COMM 14309.20 Fee summary Charged ---------- Paid Credited ------------------------------ Due ----------------- Permit Fee Total 2147.30 .00 .00 2147.30 Plan Check Total 1242.28 900.00 .00 342.28 Other Fee Total 17769.93 .00 .00 17769.93 Grand Total 21159.51 900.00 .00 20259.51 LQPERA1IT