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RC (04-4556)78010 Main St Ste 200 04-4556 BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 (760).777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT 3 7004 Application Number `04-00004556Date 6./03/04 P, Bopp--r ttyj',Address . . . . . 78010 MAIN ST STE 200 APN : PI EDE'. 770-121-002- - - Tenant nbr, name . . . . . . 200 ANTHONY CAPOBIANCO-OFFICE Application description . . . REMODEL - COMMERCIAL Property Zoning . . . . . VILLAGE COMMERCIAL Application valuation 15374 Owner OLD TOWN LA QUINTA 78080 CALLE ESTADO #200 LA QUINTA CA LA QUINTA CA 92253 Contractor ------------------------ MARVIN INVESTMENTS, INC. - 78080 CALLE ESTADO SUITE 201 LA QUINTA CA 92253 W.CC: STATE FUND WC: 1440125' 07/01/0.4 CSLB: 771883 11/3.0/05 CCC: B -------------------------- Structure Information -------------------------- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . BUSINESS <50* Flood Zone . . . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 FIRE SPRINKLERS YES OCCUPANT LOAD 10.00 SECOND"FLOOR SQ FTG 964.00 --------------------------------------------------------------------=------- Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 171.00Plan-Check Fee 4. 111.15 Issue Date . . . Valuation 15374 Qty Unit Charge Per Extension BASE FEE 45.00 14.00 9.0000 ----------------------------------------------------------------------------- THOU BLDG 2,001-25,000 126.00 Permit . . . . . MECHANICAL Additional desc Permit Fee . . . . 19.50 Plan Check Fee 4.88 Issue Date . . . . Valuation 0 Qty Unit Charge- Per Extension BASE FEE 15.00 -- P.O. BOX 1504 _ 78-495 CALLELLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mailing Ad Architect or Engineer: VOICE (760) 777-701: FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: PvL;nneci or tnglneer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS I hereby affirm under penaltyof LICENSED CONTRACTOR'S DECLARATION 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 ' in full force and effect. o cense Class_ M License No. 77 " O J3 Date G 3 a'1 ctor . / ► V rt✓• t/tl M1c *40 K — I hereby affirm under penaltyof OWNER -BUILDER DECLARATION perjury that 1 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, atter, 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 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 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. . (--) 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) I am exempt under Sec. . B.& P.C. for this reason Date - Owner I hereby affirm under WORKERS' COMPENSATION DECLARATION . Y 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 issycl, M worke 'compensation insur aee carrier and policy Wsued. e: mer P61 NNumber t _ 1 certlty that, inthe performance of the work for which thispermit Is 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 Labor Code, I shall forthwith comply with those provisions. 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. I hereby affirm under penalty of perjury that there is CONSTRUCTIOrlaPeoGeohsructon lending agency for LENDINGAGENCY f the work for which this pem111 IS issued (Sec. 3097, CN. C.). Lender's Name Lender's Address IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT 3a ANT ACKNOWLEDGEMENT 1. Each Safety apermit subject to the conditions and restrictions set forth on this applicatioh. 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 pemtit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La Quints, 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 this county to enter upon the above-mentioned property for inspection purposes. 1--11ateJAA4dX,icnature (Applicant or Agent): . i Application Number . 04-00004556 Page 2 Date 6/03/04 Qty Unit -Charge Per 124.60 Extension 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 ---------------------------------------------------------------------------- Permit .. . . . . . ELECT - ADD/ALT/REM Additional desc Permit Fee . . . . 42.53 Plan Check Fee 8.57 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 964.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 19.28 11.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 8.25 ---------------------------------------------------------------------------- Special Notes and Comments COMMERCIAL INTERIOR T.I.-OFFICE 964 SQ.FT. B OCC. TYPE VN 2001 CODES ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ENERGY REVIEW FEE 11.12 STRONG MOTION (SMI) - COM 3.22 Fee summary ----------------- Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid 233.03 .00 124.60 .00 14.34 .00 371.97 .00 Credited Due .00 233.03 00 124.60 .00 14.34 .00 371.97