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09-0258 (DEMO)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Ta!t 4 4 4" Applicant: Architect or Engineer: IA-- BUILDING & SAFETY DEPARTMENT 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 ode, and my License is in full force and effect. License ass: B Li nse v 4161 Date: !ntractor: )ifO NER-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.). 1 ) 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 Owner: SCI PLAZA AT POINT HAPY FUND PO BOX 543185 DALLAS, TX 75381 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/19/09 Contractor: HATRAK JR; KARL J 60007 6 79470 CALLE PALMETO O 9i LA QUINTA, CA 92253 (760)799-6477 Lic. No.: 364161 ------------------ WORKER'S 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 issued. My workers' compensation insurance carrier and policy number are: Carrier E� MPT 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 w rkers' compensation provisions of Section 3700 of the Labor C d ; I shall f hwi h c inply ith rovisions. ate: i pplicant: WARNING: FAILURE TO SECURE ORKERS' CO ENSATION 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 rdinances and state laws relating to build' constr ion, and.hereby a horize re sentatives of this co my enter u n the above-mentioned propert or insp on pur /te:3 /� ignature (Applicant or Agent): Application Number: 09 0-0000258— � Property Address: 78370 -HIGHWAY 111 STE 100 APN: 604-050-048- - - Application description: DEMO - COMML/OTHER Property Zoning: COMMUNITY COMMERCIAL Application valuation: 0 Ta!t 4 4 4" Applicant: Architect or Engineer: IA-- BUILDING & SAFETY DEPARTMENT 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 ode, and my License is in full force and effect. License ass: B Li nse v 4161 Date: !ntractor: )ifO NER-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.). 1 ) 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 Owner: SCI PLAZA AT POINT HAPY FUND PO BOX 543185 DALLAS, TX 75381 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 3/19/09 Contractor: HATRAK JR; KARL J 60007 6 79470 CALLE PALMETO O 9i LA QUINTA, CA 92253 (760)799-6477 Lic. No.: 364161 ------------------ WORKER'S 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 issued. My workers' compensation insurance carrier and policy number are: Carrier E� MPT 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 w rkers' compensation provisions of Section 3700 of the Labor C d ; I shall f hwi h c inply ith rovisions. ate: i pplicant: WARNING: FAILURE TO SECURE ORKERS' CO ENSATION 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 rdinances and state laws relating to build' constr ion, and.hereby a horize re sentatives of this co my enter u n the above-mentioned propert or insp on pur /te:3 /� ignature (Applicant or Agent): LQPERMIT Application Number . . . . 09-00000258 Structure Information Construction Type ---------------------------------------------------------------------------- . . . . . TYPE V - 1 HR Permit . . . DEMO PERMIT Additional desc . . Permit Fee . . . . 45.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 9/15/09 Qty Unit Charge Per Extension BASE FEE 45.00 ---------------------------------------------------------------------------- Special Notes and Comments REMOVE ALL MIRRORS AND CENTER FREE STANDING COLUMN Fee summary Charged Paid Credited Due ----------------- -------------------- ---------- ---------- �. Permit Fee Total 45.00 .00 .00 45.00 Plan Check Total .00 .00 .00 .00 Grand Total 45.00 .00 .00 45.00 • 1. Bin # City of La Quinta Building & Safety Division , P.O. Box 1504, 78-495 Calle Tampico Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit #S (9qLa Project Address: Owner's Name:-(� fU A. P. Number: Address: 'W3:�O vi l It Legal Description: Contractor: �� ��� City, ST, Zip:out yVjzt CA 7i-2- Telephone: Address: 7r17(J �`[ �I�Lt�� Project Description: City, ST, Zip: 44V 1,k 1-4 4. Z2 S-3 Telephone: %r'f l�' . �� 7 State Lic. # : City Lic. #: Arch., Engr., Designer: S'Ade 1044vt �7i� JIT Address: City, ST, Zip: , i Telephone: a. -E- M-0 State Lic. #: Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: J�On�� (,(� Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: '7-13- Z - O Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd- Rec-4 - - TRACKING PERNM FEES Plan Sets Plan Check submitted . Item Amount Structural Cates. Reviewed, ready for corrections Plan Check Deposit Truss Cates. Called.Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2i4 Review, ready for correctionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees IN v C n 'n 0>0 ^m zmx � uzo O -n ��C 0 . --n im 4c Z®mom J m 00 r m (n LIVE WELL CLINIC D D�-� b mz z POINT HAPPY 78370 H WY 111, SUITE 100 LA QUINTA, CA 92253 ^m zmx Z- O G)- m c w -4 70 OW T G)v!u X D c-�1 m D nmz0 z0m mo z20 _0 = --lo m c/) n �m —i D n r=D O � D --q >M0 � 0 0m = En . mzD (/) 07o z zz= Cr-- D0> D = G',*y n* F - Fm Cr. 0c cnm r- m 7m mm Dz m O n OTZ = 0 0 -u� z � Cr Ov Tom -u D r O. Don ?m. �m Mir- m DO n2 U) .y D G7 cm DO:10Zt- M m 00 r m (n LIVE WELL CLINIC D D�-� b mz z POINT HAPPY 78370 H WY 111, SUITE 100 LA QUINTA, CA 92253