RC (04-3577)78065 Main St Ste 105
04-3577
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777=7012
78-495 CALLS TAMPICO x '`FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 7.77-7153
BUILDING PERMIT
Application Number . .
. . . 04-00003577 Date_,•:.•.5/24/04
Property Address . . .
. . . 78065 MAIN ST STE 105
APN:
770-121-003- - -
Tenant nbr, name ..
105 RETAIL
Application description
.. REMODEL.- COMMERCIAL
'Property Zoning
VILLAGE COMMERCIAL...
Application va.luatiori ;..
Owner
Contractor:..,.
OLD TOWN LA QUINTA
MARVIN INVESTMENTS, INC.
7808.0 CALLE ESTADO #200
78080. CALLS ESTADO SUITE 201._
LA„QUINTA.CA
:. LA QUINTA CA
92253
LA QUINTA CA
92253
WCC: STATE FUND•
WC: 1440125.
07/01/04
CSLB: 771883-,
11/30/05
CCC: B-
-------- 7 ------------
Structure Information --------------------------
Construction Type . . .
. . TYPE V - 1 HR.
Occupancy Type . . . .
. . MERCANTILE
Flood Zone . . . .
. . NON -AO FLOOD ZONE
Other struct info
CODE EDITION 2001
FIRE SPRINKLERS'.. YES
MIXED-USE ,OCCUPANCY M
OCCU'PANT`OAD
Permit .. . . . . . BUILDING PERMIT
Additional desc .
Permit Fee ..
81.00. Plan Check Fee :
52.65
Issue Date_
Valuation
5400
Qty Unit Charge
Per
Extension
BASE. FEE
45..00
4.00 9.0000 THOU BLDG 2,001-25,000
36.00
Permit . . . . .ELECT -'ADD/ALT/REM
Additional desc
Permit Fee
51.56 Plan Check Fee
12.89
Issue Date
Valuation
0
`”
Qty Unit. Charge
Per U
Extension
BASE FEE MAY 2 5 204
CITY OF LA QUINTA
15.00
T1.
P.O. Box 1504 ��GlGI
78-495 CALLS TaMPtCo VOICE (760) 777-7012FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: A ✓ 77
Date: 5 t3 G
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
Lic. No.:
-BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that) am licensed undevisions 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 / License No. 77/— 03
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of pedury.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 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structureis 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 contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , B.8 P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
1 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
issu d. (�vAty w ers' tmpensation ''aed�nce Cartier and olicy number are:
Cartier s1 u'qc P� olicy Number / and
I certify that, in the performance of the work for which this permt 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 i.
Applicant
/L,Jt�
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.
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 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 2 1%'A Signature (Applicant or Agent): ' [,JtA t.
Page
2
Application Number
04-00003577 Date
5/24/04
Qty Unit Charge
Per
Extension
903.00 .0200
ELEC
GARAGE OR NON-RESIDENTIAL
.18.06
1.00 18.5000
EA ELEC
SVC <=600V/<=200A
18.50
Permit MECHANICAL
Additional desc
Permit Fee ..
33.00
Plan Check Fee
8.25
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
Special Notes and Comments
'COMMERCIAL INTERIOR T.I.- SUITE
105
-RETAIL. 903 SQ.FT. M
OCC. TYPE
V=1 HR
W/ F.S. SUBSTITUTION.
2001 CODES
Other Fees
ENERGY
REVIEW FEE
5.27
STRONG
MOTION (SMI) - COM
1.13
Fee summary Charged
Paid. Credited
Due
Permit Fee Total
165.56
.00. .00
165.56
Plan .Check Total
73.79
.00 .00
73.79
..Other Fee Total
6.40
.00 .00
6.40
Grand'Total
245.75
00 .00-
245.75
0
jCiDY/OF LA QUINTA
-BUITI G & SAFETY DEPARTMENT
k 777-7012
` NSPECTION REQUEST LINE
777-7153
Contractor
Permit Number 04-3577
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-065 MAIN ST. STE. 105
903 S.F. COMM. INT. TI - M OCC. TYPE V 1HR.W/F.S.
SUBSTITUTION, 2001 CODES.
TYPE OF INSPECTION I DATE I INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
F SING COMBINATION 0
...HUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER (ALARMS/ BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER 2 -Q
ELECTRICAL —69
PI I IMBING
I IANICAL
PL oLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
4 -
FINAL / JOB COMPLETED v
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING