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RC (04-3578)78065 Main St Ste 107 04-3578 Ot 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 Application Number' . . . . .C— 04-0000.3.528 Date 5/24/04 Property Address 78065 MAIN ST STE 107 APN: 770-121-003- - - Tenant nbr, name . . . 107 RETAIL -HOME DESIGN & ACC. Application description . REMODEL - COMMERCIAL Property Zoning . . . . VILLAGE COMMERCIAL Application valuation ". 7580 'Owner w . C.o.ntractor k ---------- -------------- -----------------------= OLD TOWN LA QUINTA MARVIN .INVESTMENTS, INC. 78080 CALLE ESTADO #200 78080 CALLE ESTADO SUITE 201 LA QUINTA CA LA QUINTA CA 92253. LA QUINTA CA 92253 WCC: STATE FUND WC: 1440.125 07/01/04 CSLB: 771883 11/30/05 CCC:. B --------------=----------- 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 OCCUPANT`WAD "41.00 ----------------------------------------------------------------------------- Permit . . . . . BUILDING PERMIT Additional desc Permit Fee 99.0.0 'Plaan'Check Fee 64:35 Issue Date . . . Valuation 7580 Qty' Unit Charge Per Extension .BASE FEE .45.00 6.00 9.0000 THOU BLDG 2,001-25,000 54.00 Permit . . . . ELECT - ADD/ALT/REM Additional desc Permit Fee . . 58.76 ' .an C e ck. 14.69 Issue Date . . . . 6 Ura 1 u•at o n 0 Qty Unit* Charge Per BASE FEE Ay 2 5 2004 Extension CITY ®F 1-4 15.00 FIZZ SPT. P.O. BOx 1504• VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: ' .'i18 Date: Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: t 1 Dc Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I aim licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals nd my Licens is in full force and effect. '7 % t— pX3 icense Class ense No. Date Lr u ntractor 14 U V&J 01 t %b -1A4 C_ OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury 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 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.). 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. , BA P.C. for this reason Date Owner WORKERS' 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 issue xy workers' compensatip-,, once carrier aP policy number are: arrier O R Yw P/ olicy 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. Date Applicant tA— 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 Lenders 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 Ouinta, 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 cored. 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 0 Signature (Applicant or Agent): Page 2 Application Number . . . . . 04=00003578 Date 5/24/04 Qty Unit Charge Per Extension 1263.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 25.26 1.00 18.5000 EA ELEC ---------------------------------------------------------------------------- SVC '<=600V/<=200A 18.50 Permit. . . . . . MECHANICAL Additional desc Permit Fee . . . . 51.00- Plan'Check Fee 12.75 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 2.00 9.000.0 EA MECH FURNACE <=100K 18.00 2.00 9.0000 EA MECH ---------.------------------------------------------ B/C <=3HP/100K BTU 18.00 Special Notes and Comments. ------------------------- COMMERCIAL INTERIOR T.I. - SUITE 107 - HOME DESIGN & ACCESSORIES - 1263 SQ.FT. M OCC. TYPE V 1HR W/ F.S. SUBSTITUTION. .2001 CODES. Other Fees . . . . . . . ENERGY REVIEW FEE 6.44 STRONG MOTION'(SMI) - COM 1.59. Fee summary Charged Paid Credited Due Permit Fee Total 208.76 ..00 .00 208.76 Plan Check Total 91.79 .00 .00 91.79 Other Fee Total 8.03 .00 .00 8.03 Grand Total 308.58 .00 .00 308.58 Tom Tisdale Fire Chief Proudly serving the unincorporated areas of Riverside County and the Cities of: Banning Beaumont Cahmesa Canyon Lake Coachella Desert Hot Springs Indian Wells Indio Lake Elsinore La Quinta Moreno Valley Palm Desert Perris Rancho Mirage San Jacinto Temecula Board of Supervisors Bob Buster, District 1 John Tavaglione, District 2 Jim Venable, District 3 Roy Wilson, District 4 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 210 West San Jacinto Avenue • Perris, California 92570 • (909) 940-6900 • Fax (909) 940-6910 December 22, 2004 To: La Quinta Building Department Re: Final fire Clearance The Riverside County Fire Department is granting a fire life safety clearance for # LAQ-04-TI-047 / Old Town La QuintaS78-065 Main Street Suff—eg-C-107 If you have any questions contact me at 760-345-6954 Respectfully, Neal Stephenson Fire Systems Inspector