14-0804 (RC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
14-00000804
Property Address:
78353 HIGHWAY 111
APN:
604-050-008- - -
Application description:
REMODEL - RESIDENTIAL
Property Zoning:
COMMUNITY COMMERCIAL
Application valuation:
13750
Tiht 4 4 Q"
Applicant: Architect or Engineer:
-----------------
LICENSED CONTRACTOR'S DECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
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 Profession6Is Code, and my License is in full force and effect.
License Cla s: -C10 License No.: 934412
Date: l ctor.
r
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 ($500).:
(_ 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.).
(_) 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 (Sec. 3097, Civ. C.).
Lender's Name: _
Lender's Address:
'LQPERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/16/14
Owner:
HARSCH INVESTMENTS -PROPERTIES
78-401 HWY 111 STE C
LA QUINTA CA 92253
LA QUINTA, CA 92253 D
Contractor: jUN 2 3 20'+4
M & M TOTAL SERVICES
74260 VELARDO DRIVE CITYpFLAQUINTA
PALM DESERT, CA 92260 FIN I►NCEOF.PT._ ..�...
(760)779-0736
Lic. No.-: 934412
-----------------------------------------------
WORKER'S 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 requiied 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 EXEMPT Policy Number EXEMPT
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
37/00 of the Labor Code, I sh I f rthwith comply with those provisions.
Date F�C� /_7-APPlicant-� __ _-..-_--
��
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.
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 cou ty t enter upon the above-mentioned property for i p N n purposes. '
Date -S (Applicant o?Age-60 � - -
�-
LQPERMIT
Application Number .
. . . . 14-00000804
Permit
ELECTRICAL
2013
Additional•,desc
Permit Fee . . .
26.21
Plan Check Fee
.00
Issue Date . . . .
Valuation . . . .
0
Expiration Date
12/13/14
,
Qty 'Unit Charge
Per
Extension
1.00 23.8300
LS ELEC
FIXTURES, FIRST 20
23.83
1.00 2.3800
----------------------------------------------------------------------------
EA ELEC
FIXTURES, ADD'L
2.38
Permit . . .
MECHANICAL
2013 f
Additional-desc .
Permit Fee _
35.76-
- Plan Check Fee
.00 ,
Issue Date . . . .
Valuation
0
Expiration Date
12/13/14
Qty Unit Charge
Per
Extension
' 1.00 .11.9200
EA MECH
APPL REP/ALT
11.92
2.00 11.9200
----------------------------------------------------------------------------
EA MECH
VENT FAN
23.84
Permit . . .
PLUMBING 2013
Additional desc .
Permit Fee . . . .
59.60
Plan Check Fee
.00
Issue Date . . . .
-
Valuation . . . .
0
Expiration Date
12/13/14
Qty Unit Charge
Per
Extension
3.00 11.9200
EA PLBG
FIXTURE/TRAP
35.76
1.00 11.9200
EA PLBG
WATER HEATER/VENT
11.92
1.00 11.9200
----------------------------------------------------------------------------
EA PLBG
WATER INST/ALT/REP
11.92
Permit . . .
REMODEL.2013
Additional desc .
Permit Fee . . . .
91.52
Plan Check Fee
.00
Issue Date . . . .
Valuation
0 .
Expiration Date . .
12/13/14
Qty Unit Charge
Per
Extension
1.00 48.6200
LS MISC
REMODEL, 1ST 100 SF
48.62
2.00 21.4500
EA MISC
REMODEL, ADDL 500 SF
42.90
----------------------------------------------------------------------------
Special Notes and Comments
TENANT IMPROVEMENT RELOCATE
EXISTING
LIGHTING AND MECH. DUCTS AND NEW
OFFICE
LQPERMIT
LQPERMIT
Application Number . . . . .
14-00000804
-----------------------------
Special Notes and Comments
------------
-------------
WALLS AND REMODEL BATHROOM. BUILDING -IS
NOT FIRE SPRINKLED.
June 11, 2014 1:46:00 PM JJOHNSON.'
----------------=-----------------------------------------------------------
Other Fees . . . . . . . . .
BLDG STDS ADMIN (SB1473)•
1.00
PLAN CHECK,
ELECTRICAL
23.83
PLAN CHECK,
REMODEL
167.31•
PLAN CHECK,
MECHANICAL
14.31
PLAN CHECK,
PLUMBING
54.83
"
STRONG MOTION (SMI) - RES
1.38
Fee summary Charged
Paid
Credited
Due
---------------------------
----------
--------------------
Permit Fee Total 213.09
-.00
.00
213.09
Plan Check Total .00
.00
.00
.00
Other Fee Total 262.66
.00
.00
262.66
Grand Total 475.75
.00
.00
475.75
LQPERMIT
POST IN A CONSPICUOUS PLACE
Certificate of Occupancy
Community Development Department
This Certificate is issued pursuant to the requirements of Chapter 1 Section 111 of the California
Building Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 78-353 HIGHWAY 111
Use classification: BUSINESS – CHIROPRACTIC OFFICE Building Permit No.: 14-0804
Occupancy Group: B Type of Construction: VB Land Use Zone: CC
Code Edition: 2013 Sprinkler Installed: NO Occupant Load: 10
By: AJ ORTEGA Owner of Building: HARSCH, INV REALTY
Date: AUGUST 26, 2014 Address: 1121 SW SALMON ST
Building Official: TOM HARTUNG (INTERIM) City, ST, ZIP: PORTLAND, OR 97205