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11-0217 (RC)78015 Main St Ste 100 11-0217 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 Professionals Code, and my License is in full force and effect. License Class: B License No.: 814971 Date:L 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.). (_) 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: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/02/11 Owner: HOTEL MAJESTIC LLC 9701 WILSHIRE BLVD #t7MAR ..„ BEVERLY HILLS, CA 90e Contractor: 0.3 2011 NANCE ENTERPRISES INTYAF Po sox 2589 Q IiNTA FINAMGE DEFT PALM DESERT, CA 92261 (760)345-2030 Lic. No.: 814971 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 STATE FUND Policy Number 497-0002141 _ 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. —Date:_.3 Z - A Applicant: / .1 J 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 this county to enter upon the above-mentioned property for inspection purposes. /Date: 3—.47-/( Signature (Applicant or Agent): r Application Number: f _11-000002.17 Property Address: 78015 MAIN ST STE 100 APN: 770-121-007- - - Application description: REMODEL - COMMERCIAL Property Zoning: VILLAGE COMMERCIAL Application valuation: 1500 A plicant: /X_ Architect or gineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 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 Professionals Code, and my License is in full force and effect. License Class: B License No.: 814971 Date:L 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.). (_) 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: LQPERMIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/02/11 Owner: HOTEL MAJESTIC LLC 9701 WILSHIRE BLVD #t7MAR ..„ BEVERLY HILLS, CA 90e Contractor: 0.3 2011 NANCE ENTERPRISES INTYAF Po sox 2589 Q IiNTA FINAMGE DEFT PALM DESERT, CA 92261 (760)345-2030 Lic. No.: 814971 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 STATE FUND Policy Number 497-0002141 _ 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. —Date:_.3 Z - A Applicant: / .1 J 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 this county to enter upon the above-mentioned property for inspection purposes. /Date: 3—.47-/( Signature (Applicant or Agent): Application Number . . . . . 11-00000217 ------ Structure Information EXTERIOR'FLOOR SINK AT UTILITY YARD ----- Other struct info . . . . . CODE EDITION 2010 FIRE SPRINKLERS N/A MIXED-USE OCCUPANCY -----------------------------------------------7---------------------------- N/A Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 35.00 Plan Check Fee 22.75 Issue Date . . . . Valuation . . . . 1500 Expiration Date 8/29/11 Qty Unit Charge Per Extension BASE FEE 15.00 10.00 2.0000 HND BLDG 501-2,000 -----------=---------------------------------------------------------------- 20.00 Permit PLUMBING . Additional desc . . Permit Fee . . . . 21.00 Plan Check Fee 5.25 Issue Date . . . . Valuation . . . . 0 Expiration Date 8/29/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.0000 EA PLB FIXTURE 6.00 ---------------------------------------------------------------------------- Special Notes and Comments EXTERIOR FLOOR SINK AT UTILITY YARD [GREASE WASTE] AREA TO BE RAISED TO PROHIBIT RUNOFF FROM ENTERING DRAIN. AREA CONSIDERED COVERED PER CVWD INTERPRETATION SEE APPROVAL DATED 3/2/2011 - GILBERT RAMIREZ X3536. 2010 CALIFORNIA BUILDING CODES. March 2, 2011 4:10:01 PM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 Fee summary Charged Paid Credited ------------------------------------- Due ---------- Permit Fee Total 56.00 .00 .00 ---------- 56.00 Plan Check Total 28.00 .00 .00 28.00 Other Fee Total 1.00 .00 .00 1.00 Grand Total 85.00 .00 .00 85.00 LQPERMIT --d COACHELLA VALLEY WATER DISTRICT ASSESSOR'S PARCEL NUMBER 85-995 Avenue 52 , Coachella, California 92236 (760) 398-2651 APPLICATION FOR WASTEWATER INTERCEPTOR/SEPARATOR APPROVAL " APPLICANT: Submit this form with a copy of a SCALED plot plan (1" - 2(y to V= = 40' SCALE) drawn to District spocifications. A nonrefundable ling fee is required when the application is submitted. Check must be made to Coachella Valley Water payable the District Approval of this application shall remain valid for a period not to exceed one (1) year from date of payment Plan Check No. Amw.Contractor, Contact Person Address City State tip Telephone Owner Address City State Zip Telephone ` Job Prvpexty City `.. Zip Legal Description RA . -otSu S'I L6&t - SVrto l00 S i LZ -4-/L . PLEASE COMPLETE THIS SECTION FOR REVIEW OF -FOOD- ESTABLISMA-ENTS- F FOOD -ESTABLISHMENTS - N071: NOTE: PLANS WILL NOT BE ACCEPTED UNLESS THIS APPLICATION IS COMPLETE AND THE PLAN CHECK -FEE IS PAID. GENERAL CONSTRUCTION: Type of Construction: New Food Facility Remodel of Exiatirrg Food Establishment Hours of Operation Seating Capacity: Internal External Fxtemal Seating with Misters or Heaters Bar with Food Service Bar Nonfood .Service Water Softener Service: Multiservice (reusable) Single Service (dispo-ble) OWNER/REPRESENTATWE DECLARATION: I cer* that I have read the eatim application and state that all information is correct. I understand diet the amount of fee paid is based on my declaration of information on this form and that incorrect information is grounds for denial of the submitted plass. I also understand that plans will be discarded if not picked up within sixty (60) days of approval or denial and that no inspection of my establishment will be conducted, or approval granted to operate, until all proper information ted has bees tecaved and plans have baa approved end returned Sigrmdue Dau — -/1 ri . ,.. TIIti;[ :-1.1<<)'1'{: rk` !Ha= 8' ' k .i. y+..«3 r'„i(.• ,•x.. •y4 ',: [ +; _ _ ' f,::' .. c' tr •' T No of Systoms Type of Systems) No. Dwelling Unita [ Sand/Otl ~ ❑ e.+e httertxQtor Waived . F'utme units ❑ New a LJW TmpIntexeeptor ❑ Replacermeat ❑ Addition [j Clarifier 1:3 Connect to Sewer REMARKS: All F!W-_P`pftcaUon is: 14 Approved ❑ Denied 13 Conditional Approval- Fee S Check No. 'Ser Remarks Date InitialSignature Date CVWD•921 CITY OF LA OUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION %eTC 'b 21?ell ov( , • rrl e R, 13j, rs 00 c Q Lc Ln p P ' o • rrl e 00 c • 'iB•a6 waw 9ae , c w aao 00 c Q Ln o -owl.. ^. • Z LA 'iB•a6 waw 9ae , c w aao Bin # City of La Quinta Building &r Safety Division P.O. Box 1504, 78.495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 1t. 021? Project Address: �� © �— F A. P. Number:s k; /eD, Owner's Name: S ` c �Z Address: _ S S L. 60 Legal Description: City,ST Zip: c Contractor:Ie� Telephone: .:t.s;;�:>A>::'s.:n?«>>�>:!<<>�<:'•. Address: Project Description: S e e� City, ST, Zip: ��, �Q �c C 2Z n Telephone: ��o _ a........>........:..:.{::;::.::.,:.::::.r State Lic. # : ( City Lie. #: Arch., Engr., Designer: Address: City, ST, Zip: Telephone: ><:: Construction Type: Occupancy: State Lic. #: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit A Truss Calcs. Called Contact Person Plan Check Balance .�. Title 24 Calcs. Plans picked up Construction1S 1� Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing S Grant Deed Plans picked up S.M.I. �. H.O.A. Approval Plans resubmitted Grading i IN HOUSE:- '"' Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue t Ito& em School Fees 1 1 Total Permit Fees (0— �IZ�'ioN� 1JSI4hwo "0040