04-5391 (RC)BUILDING & SAFETY DEPARTMENT
cw4 P.O. Box 1504 (760).777-7012
�'►lOF 4.9 78-495 C.ALLE TAMPICO FAX (760) 777-7011
• LA QUINTA; CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
w prn
iAd!d umber (04 00005391 Date 7/09/04
nop y 8902 HIGHWAY 111
CC6`(aARNr) 643-080-051- - -
Application description REMODEL - COMMERCIAL
Property Zoning REGIONAL COMMERCIAL
Application valuation.. 5000
Owner Contractor
ONE ELEVEN LA QUINTA DCD DEV INC DBA DESERT CITIES
C/O SABBY JONATHAN 46753 ADAMS ST
42620 CAROLINE CT STE 102 LA QUINTA CA 92253
PALM DESERT CA 92211 (760) 771-3345
WCC: STATE FUND
WC: 1770749 Oi/01/05
�i CSLBr' 768595 09/30/05
CCC: B -C8.
------ Structure.Information AS BUILT ELECTRICAL & GAS.-
Construction
AS. Construction Type . . . . . TYPE V - NON RATED
Other struct info . . . CODE EDITION 2001
FIRE SPRINKLERS YES
Permit ELECT.- ADD/ALT/REM
Additional'desc
Permit Fee 47.55 Plan.Check Fee 11.89
Issue Date Valuation 0
Qty Unit.Charge Per Extension
BASE FEE 15.00
20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15,.00
39.00. .4500 EA ELEC DEVICE/FIXTURE >20 17..55
--------------------------------------------------------------------------------
Permit . . . . . .. PLUMBING
Additional desc
Permit Fee 25.50 Plan Check Fee 6.38
Issue Date Valuation 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00
10.00' .7.500 EA PLB GAS PIPE >=5 7.50
-- - - - - - - - - -
Special Notes and Comments
As -built electrical & gas'line..
9
P.O. Box 1504 - • /: •
w VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 0g• -S -T? I Date:
Applicant: .�
Applicant's Mailing Address:
Architect or Engineer:
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IBMJ/ is' a'�� •�
BUILDING PERMIT 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 U is in full force pnd effect.
License Clas3 License No.
Date"7-a -c>4—contractor L4 CC t
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the ntractors' 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).):
(--) 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
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.).
U 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 contractors) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 have and will maintain a certificate of consent to self4nsure 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
m sue My cers' a pensation insurance carrier and polity num rare:
Cartier Policy Number 1.7`7:Z%
_ 1 certify that, irf the performance of the work for.which this pernmt 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.
Date 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.
CONSTRUCTION LENDING AGENCY
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.
I. 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 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 to enter upon the above-mentioned property for inspection purposes.
Date Signature (Applicant or Agent):
Page 2
Application Number. . . . . . 04-00005391 Date 7/09/04
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Special Notes and Comments
deffered submittal for Shell Permit
#0309-151 at,exterior dining area only.
Permit does not approve heater
appliances.
Fee summary, Charged Paid Credited Due
Permit Fee Total 73.05 .00 .00 73.05
Plan Check Total 18.27 .00 .00 18.27
Grand Total 91.32 .00 .00 91.32