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05-0884 (RC)T_ (.14f 4 4 Q" BUILDING & SAFETY DEPARTMENT P.O. BOX 1504 } r. (760).777-7012 78-495 CALLS TAMPICO ; `} FAX (760) 777-7011 �,A QUINTA; CALIFORNIA 92253 INSPECTION REQUESTS (760) 777 7153 Application Number . . Property Address . . . APN: Application description Property Zoning . . . . Application valuation . BUILDING PERMIT { ,.r C0 5=0-0-0-0-0-8-8 4 `' 1. Date 3/24/05 78370 HIGHWAY 111 STE 260 604-050-048 - - . . . REMODEL - COMMERCIAL . . . COMMUNITY COMMERCIAL . . . 7000 Owner ------------------------ MADISON PTM LA QUINTA 71361 SAN GORGONIO RD RANCHO MIRAGE ., CA 92270 Contractor ------------------------ PRIMUS CONTRACTING GROUP, INC 1409 SO. 600 WEST,'SUITE D BOUNTIFUL UT 84010 ' WCC: STATE FUND WC: 17051811. 10/01/05 CSLB: 814726 11/30/06 CCC: B *� ------------------=------- Structure Information ------------------------- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . BUSINESS <50 Other struct info . . . . . CODE EDITION 2001 FIRE SPRINKLERS YES MIXED-USE OCCUPANCY B OCCUPANT LOAD 43.00 ---------------------------------------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 4234.00 Permit . . . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 90.00 Plan Check Fee 58.50 Issue Date . . . . Valuation 7000 Qty Unit Charge Per Extension BASE FEE 45.00 5.00 9.0000 ---------------------------------------------- THOU .BLDG 2,001-25,000 45.00 Permit . . . . . ------------------------------ ELECT - ADD/ALT/REM Additional desc . . r,." Permit Fee . . . . 99.68 Plan Check' Fee' . . 24.92 Issue Date . . . . Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 4234.00 .0.200 ELEC GARAGE OR NON-RESIDENTIAL 84.68 Permit . . . . . . --------------------------------------- MECHANICAL Additional desc Permit Fee . . . . 19.50 Plan Check Fee . 4.88 Issue Date . . . . - t: Valuation . . . . 0 (f P.O. BOX 15 0 4r�G� ,� 4Y VOICE (760) 777-7012 7i3-495 CALLS TAhfPICD FAX (760) 777-701 I LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: 01014405 Applicant: I Architect or Engineer: Applicant's Mailing Address: Architect or Engineer's Address: 16,1/4 Lic. No.: ISUILUING HERMIT DECLARATIONS 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 License No. Date Contractor. 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 KI�/ 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.). 11X 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 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 issued. My workers' compensation insurance carrier and policy number are: Carrier Policy 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 Iforthwith comply with provisions. c 2 at®' e ✓/ �-y I�� lir" 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 Lender's 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 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 constructi ,and her by authorize representatives of this cou (y to enter u on eabove-mentioned property for inspection purposes. Date ignature (Applicant or Agent 0 a Page 2 Application Number. . . . . . 05-00000884 Date 3/24/05- /24/05Qty QtyUnit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 ---------------------------------------------------------------------------- Permit PLUMBING Additional desc Permit Fee 48.00 Plan Check Fee 12.00 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 6.0000 EA PLB FIXTURE 30.00 " 1.00 3.0000 EA PLB WATER ----------------=----------------------------------------------------------- INST/ALT/REP 3.00 :� Special Notes and Comments -r: Commercial Remodel "Royal Bank of Canada" TI, "B" Occupancy'(4,234sgft) Type VN Sprinkled, Occupant Load 43 ------------------------------------------------------------------------------ Other Fees . . . . . . . . STRONG MOTION (SMI) - COM 1.47 Fee summary Charged Paid Credited Due Permit Fee Total 257.18-, .00 .00 257.18 Plan Check Total 100.30 .00.. .00 100.30 Other Fee Total 1.47` .00 .00 1.47 Grand Total 358.95 .00 .00 358.95 a