05-4950 (RC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
"'05-00004950 j
78740 HIGHWAY 111
643 -220 -004 -
REMODEL - COMMERCIAL
REGIONAL COMMERCIAL
250000
Architect or Engineer:
4
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Ab. 40-
Lic. No.: - - - - - - - - - - - - - - -
------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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: 13-C9 Licens lei 55149
ate: 3a _ omracto
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.).
(_ 1 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. , 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:
LQPERMTT
Owner:
LA QUINTA FURNITURE LLC
1919 GRAND AVE #2A
SAN DIEGO, CA 92109
Contractor: '
MASON, V R
7266 EDINGER AVE, STE M
HUNTINGTON BEAC1-T, 'CA 92647
(714)843-0707
Lic. No.: 455149
VOICE (760) 777-7012
FAX (760) 777-7011 '
INSPECTIONS (760) 777-7153
Date: 3/31/06
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 STATE FUND Policy Number 22775
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
37700 of the
the Lab/or Cody, I shal orthwi comply with those provisions.
tB3 e:./_��Yt(iplicarlt: /
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 J$1 00,000). 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 county ttoo)en er pon the above-mentioned property f r insp Pio urposes.
D3xe'--� Signature (Applicant or AgentlY
Application Number.
05-00004950
Permit . . .
BUILDING PERMIT
Additional desc
Permit Fee
1164.50 Plan Check Fee
756.93
Issue Date . . .
Valuation . . . .
250000
Expiration Date
9/27/06
Qty Unit Charge
Per
Extension
BASE FEE
639.50
150.00 3.5000
--------------------------
THOU BLDG 100,001-500,000
-------------------------------------------------
525.00
Permit
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
658.60 Plan Check Fee
164.65
Issue Date . . . .
Valuation . . . .
0
Expiration Date
9/27/06 �r
a
Qty Unit Charge
Per
Extension
BASE FEE
15.00
32180.00 .0200
----------------------------------------------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
643.60
Permit -.
MECHANICAL
Additional desc-
esc
Permit
Permit Fee . . . .
104.50 Plan Check Fee
26.13
Issue Date . . . .
Valuation . . . . '
0
Expiration Date . .
9/27/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
17.00 4.5000
EA MECH VENT INST/' DUCT ALT
76.50
2.00 6.5000
----------------------------------------------------------------------------
EA MECH VENT FAN
13.00
Permit . . .
PLUMBING
Additional desc .
Permit Fee . . . .
174.00 Plan Check Fee
43.50
Issue Date . . . .
Valuation . . . .
0
Expiration Date
9/27/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
16.00 6.0000
EA PLB FIXTURE
96.00
1.00 15.0000
EA PLB BUILDING SEWER
15.00
1.00 7.5000
EA PLB WATER HEATER/VENT
7.50
1.00 3.0000
EA PLB WATER INST/ALT/REP
3.00
30.00 .7500
EA PLB GAS PIPE >=5
22.50
LQPERMIT
LQPERMIT
Application Number . . . . . 05-00004950
j
Permit PLUMBING:
Qty Unit Charge Per
Extension
1.00 15.0000 EA PLB GAS METER
15.00
----------------------------------------------------------------------------
Special Notes and Comments
Commercial Remodel "Linders Furniture".
TI, 32,180. sqft,. "M"/11S1" Occupancy,
Type VN Sprinkled, Occupant Load 889.
----------------------------------------------
Other Fees . . . . . . . . . STRONG MOTION
(SMI) COM
52.50
Fee summary Charged Paid
Credited
Due
---------- ----------
Permit Fee'Total 2101.60 .00
----------
.00
2101.60
Plan Check Total 991.21 .00
.00
991.21
Other Fee Total --•52.50 .00
.00
52.50 r
Grand Total 3145.31 .00
.00
3145.31
kBin #
City of La Quinta
Building U Safety Division
.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P
vo
0`J
Project Address: �� /
Owner's Name: N
A. P. Number:
Legal Description: '
Address: 7410
City, ST, Zip:
Contractor:
Telephone./(a/y ,. fi
,
Address: Q ��
Project Description:
City, ST, Zip:
Telephone• &4'
�'
State Lic. # : �j Y�
City Lic. #:
Construction Type: Occupancy:
Arch., Engr., Designer:
C�
Address: /3,
City, ST, Zip:
Telephone: 910 6 f!" `
_L
State Lic. 1ju."`I 111
Name of Contact Person:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft::2
# S ies: Z
#Units:
Telephone # of Contact Person: _r ✓t71
7
C: �o
Estimated Value of Proje Z 1� ,
%O S8 '717 APPLICANT:
DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
11%
Item
Amount
Structural Cates:
Reviewed, ready foe corrections
Plan Check Deposit . .
Plan Check Balance
Truss Calcs.
Called Contact Person
qty-nergy
Cates.
Plans picked up
�L
Construction
Flood plain plan
Plans resubmitted
�!�
Mechanical
Electrical
I
Plumbing
S.M.I.
Grading planA
2°° Review, ready for correctio=—Z
_/ �
Subcontactor List
;,Called Contact Person F'
_ _ �I�f _
3/�/"w
'Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
Grading
Developer Impact Fee
A.I.P.P.
IN HOUSE:-
7rd Review, ready for corrections/issue
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
110` 1 w L4 T WX"-�i
"Certincate ofOccupan'
.Y
Building & Safety Department
This. Certificate is issued pursuant to the requirements. of Section 109 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: 78-740 HIGHWAY 111
Use classification: RETAIL FURNITURE STORE
I
Occupancy Group: M/S1 Type of Construction: VN "SPRINKLED
Owner of Building: LA QUINTA FURNITURE LLC
Z
Building Official
Building Permit No.: 05-4950
Land Use Zone: CR
Address: 78-740 HIGHWAY 411
City, ST,'ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL .
Date: 08-18-2006
IN A CONSPICUOUS PLACE