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12-0254 (RC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 plication Number: 12-00000254 Property Address: - 78752 HIGHWAY 111 APN: 643-080-039-14 -000000- Application description: REMODEL - COMMERCIAL Property Zoning: REGIONAL COMMERCIAL Application valuation: 75000 Applicant: Architect or Engineer: ------------------ LICENSED CONTRACTOR'S DECLARATION BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I a nsed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business rofe als Code, and my License is in full force and effect. License Class: B License No 4 228 2 Date: 7`(Contractor: 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 apermit 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—) 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: PARAGON COMMERCIAL GROUP 800 PARKVIEW DR. N EL SEGUNDO, CA 90245 Contractor: BRUCKSCHLAGER, CARL 6823 CANYON HILL DRIVE RIVERSIDE, CA 92506. (951)780-1513 Lic. No.: 401228 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 4/23/12 D pn I_.N r%F 1.xQUi�� ---------------------7------------------------- 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 1822153 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 a become subject to the workers' compensation laws of California, and agree that, if I sh come�sejeyt to the worker ' mpensation provisions of Section �•-/, 377,0000 of the Labor ode sha rtryyii comply w' ose provisions. Date: 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, cessation of work for 180 days will subject permit to cancellation. certify that I have read this application and state that thea e i or o rect.. I agree to comply with all city and county ordinances and state laws relating to bur g s ti , a ereby authorize repre tatives /o/f�this county to eent�teer/flpon the above-mentioned pro r i e on p poses. r Date�� gnature (Applicant or Agent Application Number 12-00000254 Structure Information Construction Type . . . . . TYPE V, UNPROTECTED . Occupancy Type . . . . BUSINESS <50 Other struct info . . . . . CODE EDITION 2010 FIRE SPRINKLERS NO OCCUPANT LOAD 30.00 ----------------------------------------------- IST FLOOR SQUARE FOOTAGE ----------------------------- 28950.00 Permit . . BUILDING PERMIT Additional desc . Permit Fee . . . . 527.00 Plan Check Fee 342.55 Issue Date Valuation 75000 Expiration Date 10/20/12 Qty Unit Charge Per Extension BASE FEE 414.50 25.00 4.5000.THOU BLDG 50,001-100,000 112.50 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 45.75 Plan.Check Fee 11.44 Issue Date Valuation. 0 Expiration Date 10/20/12 Qty. Unit Charge Per Extension BASE FEE 15.00 41.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 30.75 Permit MECHANICAL Additional desc Permit Fee 28.50 Plan Check Fee 7.13 Issue Date . . . . Valuation . . . . 0 Expiration Date 10/20/12 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 4.5000 EA MECH VENT INST/ DUCT ALT 13.50 Permit PLUMBING Additional desc . Permit Fee . . . . 51.00 Plan Check .Fee •12.75 ` Issue Date . . . . Valuation 0 Expiration Date,. .10/20/12 LQPERMIT Application Number . . . . . 12-00000254 " Permit . . . . . . PLUMBING 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 1.00 3.0000 EA PLB FIXTURE DRAIN/VENT REP/ALT 3.00 ---------------------------------------------------------- ----------------- Special Notes and Comments INTERIOR TENANT IMPROVEMENT FOR A BANK. 2950 SF. "B" OCCUPANCY,TYPE V -B CONSTR. 30 OCCUPANT LOAD. TENANT: PROVIDENT BANK. 2010 CODES ARCHITECT: STEVEN WEINSTEIN: C18183 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ACCESSIBILITY.PLAN REVIEW 34.25 BLDG STDS ADMIN (SB1473) 3._00 ENERGY REVIEW FEE 34.25 Fee summary Charged Paid Credited Due Permit Fee Total 652.25 .00 .00 652.25 Plan Check Total 373.87 .00 .00 373.87 Other Fee Total 71.50 .00 .00 71.50 Grand Total 1097.62 .00 .00 1097.62 LQPERMIT .. qwl_ 14 fIt Bin. # .11l cl City of La Quinta Buildlng 8L 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: a ( W 1l� er's Name: . R�� n �m't�rc� 6v A P. Number. S �. Lega[ Description: Q� Gl (` !✓ Contractor. -. FAddress: ST, Zip; e U Q Telephone: ,. ;�•.?;;• „,�q»,:!�. Project Description: Te 1J�S`P S Address: City, ST, Zip: Telephone: M, '? �s c�d�A�r e Wks P State Lic. #: City Lic. #•: Arch, Engr., Designer. Address: .Dfv— Q City., ST, Zip: Telephone ', 3a'� `O 3� .� _ _• ' State Lic. #: Name of Contact Person: 5APJ4 J ` 1DfQ3xn Construction rype•.� Occ•upancy: Project type (circle one): New Add'n Alter Repair Demo Sq. FL:3aoO #Stories: ' #Units: Telephone # of Contact Person: 3a3. ' S (p 3 as Estimated Valine of Project S o p o APPLICANT: DO NOT WRITE BELOW THIS UNE !1 Submittal P q'd Recd TRACKING PERMIT FEES Plan Sets Pian Cheep submitted q Item Amount Structural Calcs. Reviewed, ready for orrectiona Plan Check Deposit. . Truss Cates.Called Contact Person i p Plan Check Balance Title 24 Calcs. Pians picked upMpyll'__p Construction Flood plata plan Pians resubmitted _ . j a Mechanical Giading plan 2•i Review, ready for correction rssue Electrical Subcontactor List - Called Contact Person Plumbing Grant Deed Plans picked up S,y H.O.A. Approval Plans resubmitted Grading IiV 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 Oq 7,b2. J/2 Bin. # 00City G Permit # Project Address: %� -7 2,(/ of, La Quinta . Bulldlrlg 8r Safety Division P.O. Box 1504,78-495 Calle Tampico 4-Quinta, CA 92253 - (760) 777-7012 Building Permit Application' and Tracking. Sheet ( Owner's Name:. �Q U —� 7 6 4N A P. Number. ^� Address: j �'(0 G�%i(%�AL— 4(,le Legal Description: r' Contractor. CARL �(,{ C� Sc Ct L�� ,// City, ST, Zip: P I !/ ��/ S 110 L t -( �(� 1 Telephone: .sem Address: 92-3 CA/t/ // 14 14(.t( YOU (. C( 0 k: Project Description: City, ST, Zip: le 1C—A 5,(4'CA, c?4V a Telephone: �1 9 MEN State Lie. # : 13 clot City Lie.. #; Arch., Engr., Designer: REZ,4* 4S 6:0A ; Pe ci W-.. i5 1DQd A W rA Y T -Address: 0100 CALL E Ani( k 012 City, ST, Zip: G/-� Q (.� (Al 7/4 Telephone: ,0_ 7 q.q State Lie. #:7 6• `�2 v ' . .�.,.� :• �%u ; �'_ Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: ei (_ .... uCGCSCfKa4�E2 Sq. Ft: # Stories: # Unitp: Telephone # of Contact Person: -'Estimated Value of Project 700, APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Rcq'd Recd TRACIMG PERMIT FEES Plan Sets Plan Check submitted cat Amount Structural Calcs. Reviewed, ready for corrections Plan Chcck Deposit. . Truss Cates. Called Contact Person Pian Check Balance Title 24 Calci. Plana picked up Construction Flood plain plan Plans resubmitted.'. Mechariscal Giading plan 2'! Review, ready for correctionsauue 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 corrects a Developer Impact Fee Planning Approval Cal[ed Contact Person 4j A.I.P. Pub: Wks. Appr Date of permit issue School Fees Z Total Permit Fecs (3 oof -ro