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05-3733 (RC)P.O. BOX 1504 78495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: . Property Address: APN: Application description Property Zoning: Application valuation: Applicant: 05-00003733 78370 HIGHWAY 111 STE 604-050-048- - REMODEL - COMMERCIAL COMMUNITY COMMERCIAL 7500 I hereby affirm under penalty of perjury Section 7000) of Division 3 of the Busi 4 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT , Owner: 260 MADISON PTM LA QUINTA - 71361 SAN GORGONIO RD RANCHO MIRAGE, CA 92270 Architect or Engineer: PI A DECLARATION ons of Chapter 9 (commencing with id my License is in full force and effect. I hereby affirm under penalty of perjury tjfat I am exfmpt from the Conactor's State License Law for the following reason (Sec. 7031.5, Busines ' and Professions Code: Any cy 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).: (_) 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.I. Lender's Name: Lender's Address: ri LQPERMIT Contractor: SOUTHWEST PLUMBING, INC. P.O. BOX 2006 THOUSAND PALMS, CA 92276 WCC: STATE FUND Lic. No.: C36 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/16/05 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 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 0008601-2005 01/OSA/O&Iicv Numb 731805 I certify that, in the perform Leo rk f w 'ch this permit is issued, I shall not employ any person in any manners asu workers' compensation laws of California, and agree that, if I sho d bc 'compensation provisions of Section li�� P700St the Labor Co , I i om hose provisions. WARNING: FAILURE TO SECURE WOR ERS' COtPENSATION C ERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAV PENALTIES AND CIVIL FIFES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPE ATION, 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 Ouinta, 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 applicatio4bes void if k is not commenced within 180 days from date of issuance of suon of o for 180 days will subject permit to cancellation. 1 certify that have rad this application and state that the c e comply with all city an r ances r2 state laws relating to buildd rrepresentatives of IN on the above-mentioned propertyo Da et : nature 19pplicant or_9gent . LQPERMIT Application Number . . . . . .05-00003733 Permit . . PLUMBING Additional desc . Permit Fee . . . . 63.00 Plan Check Fee 15.75 Issue Date 8/24/05 Valuation 0 Expiration Date 2/20/06. Qty Unit Charge Per Extension BASE FEE 15.00 8.00 6.0000 EA PLB FIXTURE 48.00 -------------------------------------------------------------- Special Notes and Comments -------------- Shell Plumbing Improvement in preperation of tenant improvement, Plumbing.Only.REPRINTED ON 9-15 TO REFLECT CHANGE OF CONTRACTOR. 7 ----------------------------------------------------------------------- Other Fees . . . . . . . CHANGE -OF CONTRACTOR 4.50 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- Permit Fee Total 63.00 63.00 .00 .00 Plan Check Total 15.75 15.75 .00 .00 Other Fee Total 4.50 .00 .00 4.50 Grand Total 83.25 78.75 .00 4.50 LQPERMIT dS—­�7 3 3 3 Bin# C G City of La Quinta — Building -u -Safety -Division -- ---- P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # . Project Address ' �0%� W / �-� Owner's Name: C ^c� A. P. Number: Address:)%3')0 11 KMA- Legal.Description: City, ST, Zip t Contractor: GU t) Telephone: 7-�� `.. Address: Project Description: City; ST, Zip: Telephone: r—� — State Lic. # : C City Lic. #: —moi Arch., Engr., Designer: Address: City, ST, Zip: .. Telephone: - Construction Type: Occupancy: State Lic. #: Project type (circle one)' New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: Estimated Value of Proi 4 . 6zJiz) APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted i3 Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs: Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan' 2nd Review, ready for corrections/issue 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 3 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:. Property Address: APN: Application description: Property Zoning: Application valuation: ✓ Applicant: T414t 4 4 a" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT 05=00003733 78370 HIGHWAY 111 STE 260 604-050-048- - - REMODEL - COMMERCIAL [ COMMUNITY COMMERCIAL �'"'VVV'"'JJJ' III 7500 U Au. 2005 Architect or Enginee CITY OF LA QUINU -------------------------------------------------- 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. _ licenso Class C36 License Nn_ 373896 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 Owner: MADISON PTM LA QUINTA 71361 SAN GORGONIO RD RANCHO MIRAGE, CA 92270 Contractor: WILLIAMS MECHANICAL, INC. 75090 ST. CHARLES PL, #B PALM DESERT, CA 92211 (760)341-0557 Lic. No.: 373896 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/23/05 ----------------------------------------------- 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 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 WOODITCH CO Policy Number WC1165396 _ 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, *ING:FAILURE agree that, if I should become subject to the workers' compensation provisions of Section 00oof the Labor C de, I j forthwith comp) wi t those provisions. o6ate Applica WAR 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 Quints, 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 ordina ces and state laws relating to buildingFonstruction, and herebyuthorize representatives of this count to ent upon the above -me ion pur ses. Hate: nature (Applicant or A ent): 2 Application Number . . : . . 05-00003733 Permit . . . PLUMBING. Additional desc .. Permit Fee . . . . 63.00 Plan Check Fee 15.75 Issue Date . . . . Valuation . . . . 0 Expiration Date 2/19/06 Qty Unit.Charge Per -Extension BASE FEE 15.00 8.00 6.0000 EA PLB FIXTURE 48.00 ------------------------ ------------------------------------------------- Special Notes and Comments Shell Plumbing Improvement in preperation of tenant improvement, Plumbing Only. Fee summary Charged Paid ------------------------------------- Credited -------------------- Due, Permit Fee Total 63'.00 .00 .00 63.00 Plan Check Total 15.75 .00 .00 15.75 Grand Total 78.75 .00 .00 .78.75 I K'9S-LK-09Lxej 8 ei!eS 9CO-96SELC *011 L9SO-IK-09L:euo4d llZW VO'uasad wied '-e!d s81Je40 7S O'er VJ 0609[ 31b'Q ,i-^ ,,,,, '`"/`°i../ ,,' '~' `•\•>L i w'`�~+,��`�~\`� •�. , / / '.. �w� ,,..a / ./ j ,,,,~f ~'~../ ~' ..,.'..-"; ~ 'w,p,,,.•' y •w I ;w. 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I �'"~`v/ `\..:,/''- li~~~``. /r^ ~~..t/ t I,/ 1~``"�,✓� ./ .```v,.,.� �.,,.✓'!f sem`\. � _,,..•^'`�''~� .-'". ~\.~ '/� t ..r,"rj",,r.��.,r' 4 r.-"w,O }� r '.''� ,:C't�w ',,, I r_+�`\ �•x•,,,w.. �' _,,.��''i � � � l"~.. ' l"' ."�M E `w/\�_,�,.. a ! (zj) r - U) 00 -n --i > > J) --n C < m 0 R1 4 0 _< C 0 Q M -Space -Planners & Interiors.*-, Medical A H AT -sr) ti CA MEDICAL SPACE DESIGNER Paul Yahez, I I < < > > ......... she bp ....... . ..... < 5-1 r ?`` I 1. Z oP x 1 LIn —I 416 1 1 � 1 I `'• y L 3 Cc1' � �d f � � r i�4„E• . - ' 1 .1,:. ..1,) . � N M• :.Rat 1'.._� 0 o12- j ® > 0 Ac �:IZ iVledical Space Planners & Interio it _ MEDICAL SPACE DESIGNER Paul Yahez, :' Y ., a-. fP