12-1213 (RC)46650 Adams Street Suite105
IIIIIIIIVIIIIIIVIIIIIII 66
P.O. BOX 1504 IE
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 12-00001213
Property Address: 46650 ADAMS ST STE 105
APN: 649-820-999- -
Application description: REMODEL - COMMERCIAL
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 120000
Applicant: Architect or Engineer:
IN
------------------
LICENSED CONTRACTOR'S DECLARATION
•
VOICE (760) 777-7012
S pN E FAX (760) 777-7011
BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
1 hereby affirm under penalty of perjury that I 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.: 723432
t d onvactor: rF-
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 ($500).:
1 _ 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, 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.).
(_ 1 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:
LQPERMIT
Date: 12/10/12
Owner:
INLAND AMERICAN LAQUINTA PAVIL
PO BOX 9271
HINSDALE, IL 60521
(760)613-3783 InD
Lr 1
Contractor:
CC & M INCORPORAT
23905 CLINTON KEI
WILDOMAR, CA 9259
(957)600-0783
Lic. No.: 723432
DEC 10 2012
MY OF LA QUINTA
FINANCE DEPT.
------------------
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
O 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 STATE FUND Policy Number 0010371-2012
_ 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 1 should become subject to the workers' compensation provisions of Section
3700 of the Labo ode, I sh II forthwith comply with those provisions.
ate` /lo lrpplicam _ 2, e,
WARNING: FAILURE TO SECURE WORKERS' 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 Quinta, 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 construction, and hereby authorize representatives
of his county to enter upon a above-mentionedrty for ' spe/\1clttion purposes.. ,,. ]
Date: I b S' ature (Applicant or Agent):
Application Number . . . . . 12-00001213
------ Structure Information 1,492SF TI/VB/B-OCC/28-OL/SPRINKLED
-----
Other struct info .
. . . CODE EDITION 2010
FIRE SPRINKLERS FULLY
MIXED-USE OCCUPANCY B
OCCUPANT LOAD
28.00
----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE 1492.00
Permit . . .
ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee
44.84 Plan Check Fee
11.21
Issue Date . . . .
Valuation . . . .
0
Expiration Date
6/08/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1492.00 .0200
-------------------=--------------------------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
29.84
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee
709.50 Plan Check Fee
461.18
Issue Date . . . .
Valuation . . .
120000
Expiration Date . .
6/08/13
Qty Unit Charge
Per
Extension
BASE FEE
639.50
' 20.00 3.5000
----------------------------7-----------------------------------------------
THOU BLDG 100,001-500,000
70.00
Permit . . .
MECHANICAL
Additional desc .
Permit Fee . . . .
53.50 Plan Check Fee
13.38
Issue Date
Valuation . . . .
0
Expiration Date
6/08/13
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 4.5000
EA MECH VENT INST/ DUCT ALT
4.50
1.00 16.5000
EA MECH B/C >3-15HP/>100K-500KBTU
16.50
1.00 11.0000
EA MECH.AH >10K CFM
11.00
1.00 6.5000
--------------- :
EA MECH VENT FAN
6.50
. . .
PLUMBING
Additional desc .
Permit Fee . . . .
37.50 Plan Check Fee
9.38
LQPERMIT
Application Number 12-00001213
Permit . . . . . . PLUMBING
Issue Date . . . . Valuation . . .
. 0
Expiration Date . 6/08/13
Qty' Unit Charge Per
Extension
BASE FEE
15.00
2.00 6.0000 EA PLB FIXTURE
12.00
1.00 7.5000 EA PLB WATER HEATER/VENT
7.50
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
---'----------------------------------7--------------------------------------
Special Notes and Comments
1,492SF TI/VB/B-OCC/28-OL/SPRINKLED
[EUROPEAN WAX CENTER] THIS PERMIT DOES
NOT INCLUDE ALTERATIONS TO THE'EXISTING
SHELL BUILDING OR EXTERIOR SIGNAGE. 2010
CALIFORNIA BUILDING CODES.
December 6, 2012.3:39:57 PM AORTEGA
----------------------------------------------------------------------------
Other Fees .. . . . . . . . . ACCESSIBILITY PLAN REVIEW
46.12
ART IN PUBLIC PLACES -COM
580.00
BLDG STDS ADMIN (SB1473)
5.00
ENERGY REVIEW FEE
46.12
Fee summary Charged Paid Credited
--------------------
Due
-------------------------------------
Permit Fee Total 845.34 .00 .00
845.34
Plan Check Total 495.15 .00 .00
495.15
Other Fee Total 677.24 .00 .00
677.24
Grand Total 2017.73 .00 .00
2017.73
LQPERMIT
!UQ+ 1Gw1n-UM5VX
. �1�i Q4 Q r It"
#
Qty of La Qurnta
8uikfing 8L Safety Division
P.O. Box 1504,78-495 Calle Tampico
La.Quinta, CA 92253 -:(760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
1(�
O-
Project Address: �oln'* J
Owner's Name:.
A. P. Number:
Address:
Lego[ Description:
Contractor:
City, ST, Zip: 7
Telephone: C *70) D F£, "•-;.
ff6
Address:
Project Description:Igo i
City, ST, Zip:
Telephone:
Stale Lie. # :
City Lia #;�j�%i
Arch., Engr., Desig/�n►er. �h'
Hj' Aw �� r ,
Address: l 1 we J �� �� Z1S
(��yy' i fQ'�2% '
City, ST, zip: 44
Telephone: D % Q'� ��
State Lic. #: G ��'G 33�:
_; ., >. '` :` ..."
ry' r'
d> .'..:::ki;J h.:sei
:� §'��/< .�. y>�.�,�.,�„�;
Construction Type: VVOccupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.: Q' ?j
#Stories: # Units:
Telephone # of Contact Person: 1904-17-71M
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd Recd
TRACYMG PERMITFEFS'
Plan Sets
3
Plan Check submitted ! em Amount
Structural Cnles.
?+
Reviewed, ready for corrections i► Plan Check Deposit. .
Truss Cates.
Called Contact Person �� Plan Check Balance
Title 24 Cala.
Z
Pians picked up Construction
Flood plain plan
Plans resubmitted ►t Mecltariical
Giading plan
2'' Review, ready for correction Issue Electrical
Subcontactor List
Called Contact Person 1! Y Plumbing
Grant Deed
Plans picked up S.M.I.
ILO.A. Approval
Plans resubmitted Grading
IN ROUSE:-
7id Review, ready for correctionslissue Developer Impact Fee
Planning Approval
Called Contaet Person
Pub. Wks. Appr
Date of permit issue
School Fees
'Total Permit Fees
4_
�d 1,01,a to. 41ap•
:sio s���o�t- • Teti � �2 .� .
l�] OCT 11 2012 (i
By
Certificate of Occupancy
T4hf 4 xP a"
Building &Safety Department
h This Certificate is issued pursuant to the requirements of Chapter 1 Section 111 of the California
Building Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 46-650 ADAMS ST, SUITE 105
Use classification: BUSINESS — EUROPEAN WAX CENTER
Occupancy Group: B Type of Construction: VB
Code Edition: 2010 Sprinkler Installed: YES
Building Permit No.: 12-1213
Land Use Zone: CR
Occupant Load: 28
Owner of Building: INLAND AMERICA
Address: PO BOX 9271
City, ST, ZIP: HINSDALE, IL 60521
By: AJ ORTEGA
Building Official Date: JANUARY 18, 2013
POST IN A CONSPICUOUS PLACE