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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