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12-1209 (RC)W-",:, P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 4-12-000012.09 Property. Address: 78271 HIGHWAY 111 APN: 604-050-013-2 -000000- Application description: REMODEL - COMMERCIAL Property Zoning: COMMUNITY COMMERCIAL Application valuation: 18000 Applicant: Architect or Engineer: alp VOICE (760) 777-7012 S FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT LICENSED CONTRACTOR'S DECLARATION 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.: 64.7,/870 Date: ��7� ontractor: /�/e�7 °L/% ��< C,11 +//1�%�✓� 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 (5500).: 1 _ 1 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.). (_ 1 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 ISec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT Owner: M & H REALTY PARTNERS II C/O CPTS NO 2170 1371 OAKLAND BLV NO 200 WALNUT CREEK, CA 94596 Contractor: CONTRACTOR MANAGEMEN' 4950 W. 145TH STREET HAWTHORNE, CA 90250 (310)343-4343 I Lic. No.: 647870 Date: 1/07/13 7UP JAN 0 7 2013 CIN OF LA QUINTA I Gt!uA..w— — - I WORKER'S COMPENSATION DECLARATION 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 REPUBLIC INS Policy Number A1CW91791204 _ 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 bec asubject to the workers' compensation provisions of Section / 3700 of the labor Code, 1S ((forthwith comply with those provisions. Date: plicant: WARNING: FAIL RE TO SEC RKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER T RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001. 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 buildi�Uandshereby representatives of}hig'county to enter upon he above-mentioned property Date: /-7-0 S' nature (Applicant or Agent): 1 Application Number . . . . . 12-00001209 ------ Structure Information EXISTING VON'S GROCERY STORE ----- Other struct info . . . . . CODE EDITION 2010 FIRE SPRINKLERS yes MIXED-USE OCCUPANCY B OCCUPANT LOAD .00 1ST FLOOR SQUARE FOOTAGE ---------------------------------------------------------------------------- 97.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 189.00 Plan Check Fee 122.85 Issue Date . . . . Valuation . . . . 18000 Expiration Date . . 7/06/13 Qty Unit Charge Per Extension BASE FEE 45.00 16.00 9.0000 THOU BLDG 2,001-25,000 ----------------=--------------------------------------=-------------------- 144.00 Permit ELECT -.ADD/ALT/REM Additional desc . Permit Fee . . . . 16.94 Plan Check Fee 4.24 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 7/06/13 Qty Unit Charge Per Extension BASE -FEE 15.00 97.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL -----------------------------=---------------------------------------------- 1.94 Permit . . . MECHANICAL Additional desc . Permit Fee 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation 0 Expiration Date 7/06/13 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 4.5000 EA MECH VENT INST/ DUCT ALT 18.00 ---------------------------------------------------------------------------- Special Notes and Comments ' INTERIOR REMODEL TO EXISTING PHARMACY TO CREATE NEW CONSULTATION ROOM (48SF) AND STORAGE ROOM (49SF)2010 CODES. STRUCTURAL ENGINEER: KISHOR M. NAK 2668 Other Fees . . . . . . . ACCESSIBILITY PLAN REVIEW 12.22 LQPEBMIT • r Application Number . . . . . 12-00001209 -------------------_-------------------------------------------------------- Other Fees BLDG STDS ADMIN (SB1473) 1.00 HOURLY PLAN CHECK 262.50 STRONG MOTION (SMI) - COM 3.78 Fee summary Charged ---------- Paid ---------- Credited -------------------- Due ----------------- Permit Fee Total 238.94 .00 .00 238.94 Plan Check Total 135.34 .00 .00 135.34 Other Fee Total 279.50 .00 .00 279.50 Grand Total 653.78 .00 .00 653.78 Qty, of 4 Quitica W. Ow 1504,'7849S CAO TampkD 4.Wnta, CA 9225J - 4760) 777-7012 ee t PmJ*aAd&=. 78846 SPYGLASS HILL DRIVE'- DdN PLOTE . A. P. Nwkb-- 770-060-001-5 Co=cwr GENERAL A/C & HEATING Now Addr—, 31170 RESERVE DRIVE CHANGE OUT (2) FIJRNACEE� Ck� ST. Zkl- THOUSAND PALMS, CA 92276 70,000 & 90,000 BTU Telq*a= 760-343-7488 rt6-3R Cl 43!�� 0 SWm d.V (;nwt Dad Mmffcmbmldcd