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04-4816 (RC). , . ., �: *TUq� .4 4 Qgbt&V . Box 1504. 195 CALLE TAMPIC.O QUINTA,.CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760),777-7012. FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number x'04-0.0004816%_ Date 6/08/04 Property Address 77985 AVENIDA MONTEZUMA AP14: 773-104-036-24-000000- 000000- Application-description Applicationdescription REMODEL'7 COMMERCIAL Property Zoning . . . : VILLAGE COMMERCIAL Application valuation ..: 70000 Owner Contractor' ---------------------- TED NEWAL SCRIVENS'CONSTR, INC.', G.L: P.O. BOX 1574 61400 YUCCA ROAD LA.QUINTA. CA 92253MOUNTAIN CENTER. :CA`92561 (760) 349-3327. WCC: STATE FUND WC: 8.0.75415.: 01/01/05 CSLB: 807645 05/31/06 :.;..:.: CCC: B ------. Structure Information:.CONVERT GAS STATION TO MARKET ----.- Construction Type TYPE W- NON RATED —A_c_cup.ancy—Ty��—. --_- _.---•---•---._..—MERCANTILE.-- --=------------- �--- -=------ Flood Zone . . . . . .. . . NON=AO FLOOD ZONE c Other struct info... CODE EDITION.. 2001 CBC FIRE SPRINKLERS YES OCCUPANT LOAD .00 Permit . . . . BUILDING PERMIT Additional desc . :. .. Permit. Fee. ' 504.50 Plan Check Fee 327.93 Issue Date .. Valuation 70000 Qty Unit Charge Per Extension BASE FEE 4.14.50 20'.0.0 4.5000 THOU BLDG 50,001-100,00.0 90:00. Permit ELECT,-. ADD/ALT/REM - ` Additional . desc Permit Fee. ...... 52.50 Plan Check Fee _ - 13.13 Issue Date ...". Valuation .. 0 .:Qty Unit Charge Per Extension BASE FEE 15.00 50.00 .7500 PER ELEC DEVICE/FIXTURE IST 20 37.50 Permit . . . . . MECHANICAL �1 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 ' BUILDING & SAFETY DEPARTMENT Application Number: l Applicant: Applicant's Mailing Address: VOICE (760) 777-7012 FAX (760) 777 -7011 - INSPECTIONS (760)'777-715,3 Date: Architect o Engineer: Architect or Engineer's Address: Lic. No.. BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION 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 isjq full force and effect. �O 6 y J License Class_ la License No. / r 1 Date 'U -49' 6q /'contractor L . Sc ✓ !e N s Q S� ("�. c�I d,.� ,J L OWNER- UILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).): U 1. as owner of the property, or my employees with wages as their sole compensation, will do the worts, 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 or 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.). U 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 Me Contractors' State License Law.). U I am exempt under Sec. BA P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION hereby affirm under penalty of pedury one of the following declarations:.. I have and will maintain a certificate of consent to self4nsure for workers' compensation, as provided for by Section 3700 of ft 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 a d )Jicy num V 7' r Seo, Carrier Policy Numberb -O0 7 I certify that, in the performance of the work for which this permit is issued, I shag not employ any person In any manner so as to become subject to the workers' . compensation laws of Califomia, and agree that, If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. . Dated OC( Applicant WARNING: FAILURE TO SECURE WORKERS' CO ENS N COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR $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. 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 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 co ply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to este u above-meintion property for inspection purposes. --Date V Signature (Applicant or Agent): Page 2 Application Number 04-00004816 Date 6/08/04 Additional desc Permit Fee . . 39.50 Plan Check Fee 9.88 Issue Date Valuation . . 0 Qty Unit Charge. Per Extension BASE FEE 15.00 1.00' 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 1.00 .6.5000 EA MECH VENT FAN 6.50 --------- - ---------- Permit . . . . PLUMBING Additional desc . Permit Fee 115.50 Plan Check Fee 28.88 Issue Date Valuation 0 Qty Unit Charge Per Extension BASE .FEE 15.00 15:00 6.0000 EA PLB FIXTURE 90.00 1:0.0 .7..5000 EA PLB WATER HEATER/VENT 7.50 1.00 3.0000, EA PLB WATER INST/ALT/REP 3.00 --------------------------- Special Notes and Comments CONVERT GAS STATION TO RETAIL MARKET ------------------------.----------------------------------------------------- Other Fees . . . . . . . STRONG MOTION (SMI) - COM 14.70 Fee summary Charged Paid Credited Due ----------------- ----------- ---------- ----------- ---------- Permit-Fee Total 712.00 .00 .00 712.00 Plan Check Total 379.82 .00 .00 379.82 Other. Fee Total 14.70. 00 .00 14.70 Grand Total 1106.52 .00 .00 1106.52 A x GA 11 fv'W- 1/1A PW A PP2. Q of La Quinta / cDv Bad �irL �f 11 y0 Building �[ Safety Division Permit # .O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 D yD y -O b ilding Permit Application and Tracking Sheet Project Address: p8s Owner's Name:�' A. P. Number. 773-1,9-9t, o ,3,c Address: Leval Description: Ciry. ST, Zip: Contractor. "��.•.--. FTcicphonc: , ._... - `7~ Address: Xproject Description: City, ST, Zip:4/7 e - Telephone: J 7 State Lic. # :W 6 j City Lic. #: 0"O'L— Arch., Engr., Designer. ` ZY, V! Address: ,,( �Y1 fc/ City, ST, Zip: Telephone: Construction Type: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: V t m LRde G Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: G stimated Value of Project: ZC2 pd APPUCANT: DO NOT WRITE BELOW THIS UNE # Submittal Req'd Rec'd TRACKING PER1fIT!EES Plan Sets d2 Plan Check submitted Y ? Item Amount Structural Cala. Reviewed, ready for corrections AIMPlan Check Deposit Truss Cala. Called Contact Person Plan Check Balance Energy Cala. Plans picked up !�7 v Construction Flood plain plan Plans resubmitted M1tech2nic21 Grading plan V Review, ready for correction sane Electrical Subcontactor list Called Contact Person Plumbing Grant Decd Plans picked up SAA. H.O.A. Approval Plans resubmitted Grading Developer_ Impact Fee A.I.P.P. IN HOUSE:- '"' Review, ready for correctionsltssue Planning Approval Called Contact Person Pub. Wks. Appr Date of pe mit issue (Q 8 v School Fees r -y Q S,t' ..,.tet- i. �, R...,., � nLJ� a ..l -n u Total Permit Fee 11 fv'W- 1/1A PW A PP2. 4f� y cDv Bad �irL �f 11 P O A 0k, �T