11-0951 (RC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
ice'" /_ r
Application Number: r11-00000951
Property Address: c-78670 HIGHWAY 111
APN: 643-220-001-2 -000000-
Application description: REMODEL - COMMERCIAL
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 58000
(;eiilt °f 4Qa4rw
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 Professionals Code, and my License is in full force and effect.
License Class: B License No.: 801358
oat e`�Contraal or.\ -
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).:
(_) 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, 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. , BAP.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:
WASHINGTON ADAM PARTNERSHIP
43692 PIASANO PL
TEMECULA, CA 92592
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/12/11
r dU Allo
Contractor:
HINES CONSTRUCTION Ecol n T "l-' )
740 MOUNTAIN SHADOWS DRIIJ
CORONA, CA 92881
(951)371-1950
Lo
Lic.. No.: 801358
-----------------------------------------------
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.
_ 1 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 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
3700 of the Labor Code, I shall forthwith comply with those provisions.
")Dar to 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. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of this county to enter upon the above-mentioned property for inspection purposes.
Date: �.z_�i`%r , Signature (Applicant or
-Application Number .
. . . . 11-00000951
Structure Information
Construction Type . .
. . . TYPE V, UNPROTECTED
Occupancy Type
MERCANTILE'
Other struct info . .
. . . CODE EDITION 2010
FIRE SPRINKLERS YES
OCCUPANT LOAD
35.00
----------------------------------------------------------------------------
1ST FLOOR SQUARE FOOTAGE 1181.00
Permit . . .
BUILDING PERMIT.
Additional desc ...
Permit Fee . . . .
450.50 Plan Check Fee
292.83
Issue Date . . . .
Valuation
58000
Expiration Date
5/19/12
Qty Unit Charge
Per
Extension
BASE.FEE
414.50
8.00 4:5000
---------------------------------------------------------------
THOU BLDG 50,001-100,000
-------------
36.00
Permit . . .
ELECT - ADD/ALT/REM
Additional.desc .
Permit Fee
52.50 Plan Check Fee..
13.13
Issue Date
Valuation . . . .
0
Expiration Date..
5/19/12
Qty Unit Charge
Per
Extension
-
BASE FEE
15.00
20.00 .7500
PER ELEC DEVICE/FIXTURE 1ST 20
15.00 (•
50.00 .4500
----------------------------------------------------------------------------
EA ELEC DEVICE/FIXTURE,>20
22.50
Permit . . MECHANICAL
Additional desc .
Permit Fee . . .
54.00 P1an.Check Fee
13.50
• Issue Date . . . .
Valuation . . . .
0
• Expiration Date
5/19/12
Qty Unit Charge'
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH-FURNACE <=100K
9.00
3.00 4.5000
EA MECH VENT INST/ DUCT ALT,
13.50
1.00 16.5000
EA MECH B/C >3-15HP/>100K-500KBTU
16.50
Permit . . .
PLUMBING'.
Additional desc .
LQPERMIT
Application Number .
. . . . 11-00000951
Permit . . . . . .
PLUMBING
Permit Fee . . . .
31.50 . Plan Check Fee
7.88
Issue Date . . . .
Valuation
0
Expiration Date
5/19/12
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 6.0000
EA. PLB FIXTURE
6.00
1.00 7.5000
EA PLB WATER HEATER/VENT
7.50
1.0.0 3.0000
EA PLB WATER INST/ALT/REP
3.00
------------------=---------------------------------------------------------
Special Notes and Comments
INTERIOR TENANT IMPROVEMENT FOR RETAIL
STORE (GNC). 1181 SF
35 OCCUPANT LOAD.
2010 CODES.
----------------- ----------------------------------------------------------
Other Fees . .
. . . . ACCESSIBILITY PLAN REVIEW
29.28
BLDG STDS.ADMIN (SB1473)
3.00
ENERGY REVIEW FEE
29.28
Fee summary Charged Paid Credited
Due
Permit Fee Total
588.50 .00 .00
588.50
Plan Check Total
327.34 .00 .00
327.34
Other Fee Total
61.56 .00 .00
61.56
Grand Total
977.40 .00 .00
977.40
LQPERMIT
Bfn.#� _
G
City. Of La QUinta
Buik mg a Safety Division
P.O. Box 1504,78-495 CalleTamptco
1A.Wnta, CA 92253 - (760) 777-7012
Building Permit ,Application'and Tracking Sheet
Permit#
1145)...
Project Address: $ , W l l 1
Owner's Name: A& W" 6 4 Dd�A�-�S ILLS
A. P. Number
Address: 1414 1-463 0,b&1111 .S S-[.
Legal Description:
City, ST, Zip: L#11 at&oLHh CA Z Z* 3
Contractor. -[.�q - D . :�/� �r�
Addre ��/Q ! sN_ Sjyd4 -tIS ,�oz _
City, ST, Zil'!!'�,>2clAi/4 CA9.2,S S I
Telephone•
State Lir •�p�.� S'` j ,. City Lic #;
Arch., Bag., Designer: _f, o
Telephone: 0.3L U - 22-' Z
Project Description. , -1
V,&qL.6,'()tA—j E aCl (..
-t:'(i Ai S:. . LA .4 -t --.A flbbAd—
VTC—:�
Address: 1 21 NN1E U -0W
City., ST, zip. t p &a; 0 X $ 2 (44 8
Telephone: * . ba ; q IQ b
State Lic. #: 3 Z
Name of Contact Person: 1� �,
Construction Type:. 'g Occupancy:
Project type (circle one): New Add'n Repair Dano
Sq. Ft.: 118 # Stories: k # Unit1
Telephone # of Contact Person: LM - S$2 .3 �F3S
Estimated Value of Project: 00 6
APPLICANT: DO NOT 4AMBELOW THIS UNE
#
Submittal
Rcq'd
Reed
TBA G PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Calcs.
Reviewed, ready for correctlo Pian Check Deposit. .
Truss C21CB.
Called Contact Person y Plan Check Balance.. .
Tide 24 Cates.
Plans plckednp nstractlon
Rood plain plan
Plans resubmitted.'. f/ Mechaelcal
Grading plea
2'! Review, ready for correction "Je "CX-7Electrical
Sutxontaetor List
Called Contact Person `p - Plumbing
Grant Deed
Pians #leked up S,M,I,
H.O.A. Approval
Plans resubmitted Grading
IN HOUSE:-
'^' Review, ready for rorreetlonsAmc Developer Impact Fee
Planning Approval
Called Contact Person A.%P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees �? •
y
• Q04V
P.O. BOX 1504 BUILDING & SAFETY DEPARTMENT
78-495 CALLE TAMPICO (760) 777-7012
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
To: Greg Butler, Building & Safety Manager a " To CDD:
From: Les Johnson; Director -Planning Due Date: q
Permit #: Status:
Building Plans Apptovral
(This is an approval to issue a Building Permit)
The Planning Department has reviewed the Building. Plans for the following
project:
Description: 7-/
Address or General Location: 78- (b 70
Applicant Contact:mwy9I' - �-�_ 3 73 S
U
The Planning Department finds that:
❑ ...these Building Plans do not require Planning. Department approval.
...these Building Plans are approved by the Planning Department.
❑ ...these Building Plans require corrections. Please forward a copy of the
attached corrections to the applicant: When the corrections are made
please return them to the Planning Department for review.
Les John n, Director -Planning Date
s �� oN S�oM'i or• �•/(oo 5/ K +vim !( !►rr X1,1
ON N
&%.%I WJA&.0 e,&*%) ^411-1 S V% *A rec
ed
i�- OJE;' X ? 2011
vity of La Quinto
Planning Department
��//__ CITY OF LA QUINTA SUB -CONTRACTOR LIST
/7��-'� �// PERMIT NUMBER OWNER BUILDER
JOB ADDRESS ��%
This .form shall be posted on the job with the Building Inspection Card at aii -tirries in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each. applicable trade, all information requested below must be completed by applicant. "On File is not an acceptable response.
Trad..e. / Classification
Contractor
,.... State:: Contractor's. License
Workers Compensation insurance .. . _
Ci y -Business License.
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp.'Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK (C-12)
-
CONCRETE (C-8)
//V6-,5 czwS "�OvcXto�
�.y�
C3�3�
FRAMING (C-5)NESh2�c�,
l3S,
t
3
. STRUCT. STEEL (C=51)
MASONRY (C-29)
PLUMBING (C-36)
SES IS uCy�pti
t�
ejo 3
G
LATH, PLASTER (C-35)
:DRYWALL (C -9)C3
HVAC (C-20)
ELECTRICAL IC -10)
ROOFING (C-39)
:SHEET METAL (C-43)
FLOORING (C-75)
GLAZING (C717)
INSULATION; (G-2)
SEWAGE DISP. (C-42)
PAINTING. (C'-33)
/io��SS j2 �yG
G 3S
C • 3(J—�
CERAMIC TILE (C-54) .
CABINETS (C-6)
FENCING (C-13)
LANDSCAPING (C=27)
POOL (C-53)