RC (04-3604)78065 Main St Ste 200
04-3604
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APP 21 2004
--OF LA QUINTA
FI IAt CE OEPT. BUILDING & SAFETY DEPARTMENT
(760) 777=012
OF'I1' 78-495 CALLS TAMPICO . FAX" (760) 777-7011
LA .QUINTA. CALIFORNIA "92253 INSPECTION REQUESTS (760)777-7153
BUILDING PERMIT
Application Number., 4 ' . C`=0-4 000.03604-3 Date 4/21/04
Property Address . . . . 78065 MAIN ST
-. APN: 770-121-003- - -
Tenant 'nbr, name BLDG C @ HOGSBREATH KITCH
Application description REMODEL - COMMERCIAL
Pzoperty Zoning VILLAGE COMMERCIAL
Application valuation' 7000
Owner Contractor
OLD TOWN LA QUINTA MARVIN INVESTMENTS, INC:.
7U80 .CALLE ESTADO #200: 78080. CALLS E.STADO SUITE 201
LA QUINTA CA LA QUINTA CA :92253
LA QUINTA "CA q,22 5 3
WCC "STATE' FUND
WC. 1440125 0.7/01/04
:CSLB: 771883 11-/.30/05
CCC._ B.
-----.-
Structure 'Information STRUCTURAL FLOOR ALTERATION TO SHELL -----
Construction Type . . . . TYPE V - 1 HR
Occupancy Type ASSY,BLDG-<30,0 NO STAGE
Flood Zone NON -AO FLOOD ZONE
"Other.struct ihfo CODE EDITION . 2001
FIRE SPRINKLERS YES
MIXED-USE OCCUPANCY A3/B/M
Permit .BUILDING -PERMIT
Addit-ional desc
Permit Fee . . . . 90.00 Plan Check Fee.."'. 58.50
Issue Date. Valuation 7000
Qty Unit Charge `'Per Ektehsion-
BASE FEE ;.45:00
5.00 9:0000 THOU BLDG 2.,001•-25.,000 45.00
Special Notes and Comments
COMMERCIAL REMODEL - STRUCTURAL
-REVISIONS TO KITCHEN FLOOR AT HOGSBREATH
AT SUITE #200'. 2001 CODES. SUPPLEMENTAL
-TO PERMIT #0211-1.94. **SPECIAL
INSPECTION,..FOR EPDXY BOLTS REQUIRED**
`Other Fees. HOURLY PLAN CHECK 140.00
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
• QUWA
BUILDING & SAFETY DEPARTMENT
Application Number: 09- 361) -I•
ApplicantW E I - L S M AR V I N
Applicant's Mailing Address:
78- bScn rAa E 1557ADO *201
LA- 0UI.vTA CA 4ZZ,S3
1
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: '1 - a41 •U y
Architect or Engineer.
14 A/ . S-rA Ni fo(,.D
Lic. No. C % 3
BUILDING PERMIT DECLARATIONS
7
UCEICAM CONTRACTOR'S DECLARATION
1 hereby aft. under penalty of pelmy rias 1 am licensed urdec provisions of
Chapter / ! / g (-99 wMh Section 7000) of Division 3 of the Business ane Proleniormis
C-061 and my Lioense}s in Wil brae and eRect
�• �t-o2l /S� � /.l�l/1O/pie/ %i%i/c�fii_ �.�.-F� ?ori' •
I
��y afcrm � Pw++ltY a OWNER4UthpER DECLARATION
city or oohrmty riot requires t pamedur em � the • State License Law for the ft§wAV rosaon (Sec, 7o31.5. Business and Profession Code Any
.City
or o ht ty t he - she k a Parmui ��' dist or � anY stnrctum � b ks issuance, also re"res Che applicant for ria permit b tie a signed
and Profession Code) or that M or b the provisions a the ConbacbW State License Law Poplar 9 (com n em9rhg with Section 7000) a Division 3 of the Business
the applicant b •civ( exempt >fhenetnotrh and the Oasis for the alleged exemption. Arhy vbhaioc► a Section 7031.5 by any appiant for a permit subjects
Ih 1, ; f owner a the �Y a not more than ire hundred do :1 (t5pp) x
Business and Pr «� e: The
�CaM acbrithw�• stab
License Law Ink safe compardatiork wiM do #0 w0k a� structure is not Intended or olterod for sob (Sec 7044•
withimself h n o Am «5s� his or her own employees• provided &W the krWovs�tls acre n Intendedor offeredof property �sale. r however. On bimproves lherem uildinwho
�srprov move t is
sold U 1, as owner a the
may' e70d" iiV* contracting rte► WO(COMPICUM the owrW-bulderwill have �a cwdbvd On p she did notbuild ori ivess forte p a sob }
Stab License Law does not appy b an owner a Protect (Sec. cls fo4.r Business and with
aconProfessionsa Code: The Co purl ad
the Cw*ackxV State License Law.) property 0 bunds a improves rieieoch, and who oorhtracts for the p!olects wMh a contractor(s) ioensed persuacnt b
U I am exempt under Sec . B.3 P.C. for this reason
Dale Owner
1 hereby affirm under penalty at perjury one of theWim• COMPENSATION DECLARATION
1 have and w0 makdain a certificate a lor p
se�u� a for workers•
/ a the work for which this pem�l Is Issued. for as provided for by Section 3700 a the Labor Code, for the performance
—1 i will maintain workers' COmpensation Insurance. as mWmd by Section 3700 a a th
issued the Labor Code. for the perfor ante e wok for whid► this permit is.
gander .. /�z� Number ,
_ I that• in the pMortm^o° a the rrak for which this isnot
employ any person in any manner so as b become arbject b the wakat•
comPensslion laws of Cai(omia, and agroe Mal r 1 should become subject b
torBnwlth oocnpty with those provisions. the wonkers• compensation provisions of section 3700 of the Labor Code. I stiatl
0
WARNING. : FAILURE TO SECURE WORKERS COMA
CIVIL EfMTlO COVERAGE IS MUZZAND SKA L SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AM
CIVIL FINES UP TO ONE .OltJPiDRED T}glJS�q 00LARS ($100.000). IN ADDITION TO TME COST OF COMPENSATION. DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, t•(TEREST. AND ATTORNEYS FEES. .
1 hereby storm wider CONSTRUCTION LENMG AGENCY
Penalty a perjury that then is a conshurbon lording agency for the perfomanoe Of the wok for which this permit is issued (Sec. 3097. Civ. C.).
Lendeh Name IL
Lenders Address
by
IMPORTANT Application is hereby
made b the Director Building and safety for a permit subject b and ns
the conditions bictions set forth on Ws application,
Issued as a n+e ot a hos application Person
INsis made, each at whose mutest and for whose benefit wok is performed under or pursuant to any permit
application, the owner. and the applicant, each agrees to, and shag. defend. indemnify and told harmless the City a La Quints. Its
2 Any permagents and emPlOyees for any ad or omission related to the work being performed under a following issuance a ri+s permiL .
it issued as • result a this application becomes null and void r wok is not commenced wtviin 160 d4ys from date of issuance of such perm!( or
cessation of work for 160 days wit subject permit b cancellation.
I
�rvCtiioort, ant I ted herreby aaut ho ntWs application and � s a tl � above in enter n is the t. agree to comply with sa city and courtly ordrhanoes and state laws relating b buildirq
coyrhty b enter upon the
above-mentioned y for Inspection ovrDoses.
/ /�
J
Page 2
.Application Number
. . . . .
04-00003604
Date 4/21/04
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Other Fees . . . .
. . . . .
STRONG MOTION (SMI) -.COM
1.47
Fee summary
-----------------
Charged
Paid
--------
Credited
Due
Permit Fee Total
----------
90.00
--
00
--- - ------
.00
7 ---------
90.00
Plan Check Total
58.50
.00
.00
58.50
Other.Fee Total
141.47
.00
.00
141.47
Grand Total
-..289.97
.00
.00
289.97