BSPN2014-001978010 Main St Ste 111
BSPN2014-0019
a.
k
78495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
STEVE KOUCHI
78010 MAIN ST. STE111
LA QUINTA, CA 92253
BSPN2014-0019
78010 MAIN ST STE 111
770121008
RETAIL STORE T.I.
VOICE (760) 777-7125
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/29/2014
Owner:
OLD TOWN LA QUINTA LLC
78100 MAIN ST STE 206
LA QUINTA, CA 92253
AUG 2 9 2014
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEI
LICENSED CONTRACTOR'S DECLARATION
I 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 Professions Code,
and my License is in full force and effect.
License Class: License No.:
Date:
Contractor:
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).:
(_) 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.).
(_J 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
Lender's Address:
Contractor:
NONE REQUIRED
Llc. No.:
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: _ Policy Number: _
_ 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 become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with those provisions.
I Date:
Applicant:
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 Building Official 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 he ove infor ion is correct.
I agree to comply with all city and county ordinances d tate laws elatin to building
construction, and hereby authorize representatives of ty t e er u n the above•
mentione pe for inspection purposes.
Date: 1 l Signature (Applicant or Age t):
Description: RETAIL STORE T.I.
NAME TYPE
Type: SPECIAL INSPECTION
Subtype: Status: APPROVED
Applied: 8/11/2014 P1U
Approved: 8/29/2014 BHA
Parcel No: 770121008 Site Address: 78010 MAIN ST STE 111 LA QUINTA,CA 92253
Subdivision: PM 30850
Block: Lot: 2
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $0.00
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0 No. Unites: 0
NONE REQUIRED
Details: RETAIL STORE ADDING DESK & TABLE. SHELVING /STORAGE TO EXISTING 432 SF SPACE. SHELVING WILL BE SECURED TO WALL PER BF
2013 CODES.
(760)548-0720
CHRONOLOGY
NAME TYPE
NAME ADDRESSI
STATE
ZIP
PHONE
FAX EMAIL
CITY
APPLICANT
STEVE KOUCHI 78010 MAIN ST. STE111
LA QUINTA
CA
92253
(760)548-0720
CONTRACTOR
NONE REQUIRED
(760)548-0720
OWNER
OLD TOWN LA QUINTA LLC 78100 MAIN ST STE 206
LA QUINTA
CA
92253
(760)548-0720
TENANT
H2O CLOSET 78010 MAIN ST 111
LA QUINTA
CA
92253
(760)548-0720
Printed: Friday, August 29, 2014 3:38:30 PM 1 of 2
B?SYSTEnAS
0
`. Permit Details PERMIT NUMBER
City of La Quinta BSPN20A`=001
A,
Imam
INSPECTIONS
SEQID INSPECTION TYPE INSPECTOR SCHEDULED COMPLETED RESULT REMARKS NOTES
DATE DATE
FINAL"
PARENT PROJECTS
Printed: Friday, August 29, 2014 3:38:30 PM 2 of 2
cT.ffTw.'YSTEMS
J
I
Bin #.
City of La Quinta
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico.
La Quints, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit # i
t Project Address: g' Q to Ma(A Owner's Name: % (3uc ) I
A. P. Number: i Address:
Legal Description: T City, ST, Zipl L1v)Gy)p r 11r CA gS27j>
Contractor: l Telephone: OC r — 07-2 L
Address: )L Project Description:
City, ST, Zip:
Telephone:
»;i::<:»>" ;>:«::.<: •:..;:;• :.. r., .r<i::. qty 1t ,
:
jCY-. ...
State Lic. #: City Lie. #; s Y / V `✓1 Sa P/ I ' ✓
Arch., Engr., Designer:
Address: Gt U 47z Mall.
City, ST, Zip:
Telephone: :::.:>.:::...;::.; ; :; •,•y < > . Construction Type: -4 Occupancy:
State Lic. #: : <.;:. ; _- ..r. • Project type (circle one): New Add'n Alter Repair Demo
L Name of Contact Person: 0U & j Sq. Ft p # Stories: #Units:
-
Telephone #,of Contact Person: 1 row a ZZ stimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACIC.DVG
PERMIT FEES
Pian Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctio sr u
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
''" Review, ready for correctionsfissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit yea
CITY OF LA QUANTA
BUILDING & SAFETY L EPT.
APPROVED
FOR CONSTRUCT Ofd
DAn c - BY
Klo
S/
8 o what N sT.
set -VIES rt t
If — 22 7/8" X 76"
')helf 2 — 46 %" X 76"
B
Dresser — 47 %" X 15 % " X 29 1/8"
Display Table — 41" diameter 29 3/8" height
r
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