05-2852 (RC) Revision 1P.O. BOX 1504 VOICE 760 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING -& SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
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Date: 9/02/05
Application Number: 4105-00002852 Owner:
Property Address: 78995 HIGHWAY 111 STE 5. WASHINGTON 111 LTD
APN:. 643-020-999-6 -30903'- C/O JACK TARR
Application description: REMODEL - COMMERCIAL 30240 RANCHO VIEJO .RD. STE. B
Property Zoning: REGIONAL COMMERCIAL SAN JUAN CAPISTRANO, CA 92675
Application valuation: 14000
Contractor:
Applicant: Architect or Engineer: UNITED STAND CONSTRUCTION FFINA
7748 SANFRANCISCO STREETHIGHLAND, CA 92346 FP O '005/(909)709-0405rrtLic. No.: 840168 OF�QUINTANCE DEPT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 700011 of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
License Class: B - License No.: 840168
Date: %Z v ntracetiq ,gel
NER-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 contractors) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , B.&P.C. for this reason f
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: tj
LQPERMIT
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 1799912
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 or Code, I shALLG.,thwith comply with those provisions.
atU e: �-� Applicant:
WARNING: FAILURE TO SECURE WORKERS' CO PENSATION 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 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 1 have read this application and state that the above information is correct. I agree to comply with all
city and count�toenter
nances a d state laws relating to building construction, and hereby authorize representatives
of this county up the above-mentioned property for' ctiOfT purposes.
/%��
Piate: Signature (Applicant or AgeCt1'
Application Number
05-00002852
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
153.00 Plan Check Fee
99.45
Issue Date . . . .
7/12/05 Valuation . . . .
14000
Expiration Date
1/08/06
Qty Unit Charge
Per
Extension
BASE FEE
45.00
12.00 9.0000
----------------------------------------------------------------------------
THOU BLDG 2,001-25,000
108.00
`Permit . . .
ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . .
43.00 Plan Check Fee
10.15
Issue.Date . . . .
7/12/05 Valuation . . . .
0
Expiration Date..
1/08/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1400.00 .0200
----------------------------------------------------------------------------
ELEC GARAGE OR NON-RESIDENTIAL
28.00
Permit . . .
MECHANICAL
Additional desc .
Permit Fee
39.50 Plan Check Fee
9.88
Issue Date . . . .
7/12/05 Valuation
0
Expiration Date
1/08/06
Qty Unit Charge
Per
Extension
BASE FEE
15.00
1.00 9.0000
EA MECH FURNACE <=100K
9.00
1.00 9.0000
EA MECH B/C <=3HP/100K BTU
9.00
1.00 6.5000
-------------------------=------------------------------------
EA MECH VENT FAN
--------------
6.50
Permit
PLUMBING
Additional desc .
Permit Fee . . . .
94.50 Plan Check Fee
23.63
Issue Date . . . .
7/12/05 Valuation
0
Expiration Date
1/08/06
Qty Unit Charge
Per
Extension
_
BASE FEE
15.00
11.00 6.0000
EA PLB FIXTURE
66.00
1.00 7.5000
EA PLB'WATER HEATER/VENT
7.50
1.00 _ 3.0000
EA PLB WATER INST/ALT/REP
3.'00
1.00 3.0000
n
EA PLB GAS PIPE 1-4 OUTLETS
3.00
LQPERMIT
Application Number . . . . .
05-00002852
---------------------------------------=-------------------------------------
Special Notes and Comments
Commercial Remodel " Happiness
Nail
Salon" TI, "B" Occupancy, Type
VN
Sprinkled, Occupant Load 46
------------------------------------
Other Fees . . . . . . .
----------------------------------------
CHANGE OF CONTRACTOR
4.50
REPLACEMENT
INSP CARD
15.00
STRONG MOTION (SMI) - COM
2.94
Fee summary Charged
----------------- ----------
Paid
- --- ------
Credited
---------- ----------
Due
Permit Fee Total 330.00
330.00
.00
.00
Plan Check Total 143.71.
143.71
.00
.00
Other Fee Total 22.44
2.94
.00
19.50
Grand Total 496.15
476.65
.00
19.50
Bin #
Permit #
Project Address:
A. P. Number:
Legal Description:
Contractor:
Address:
City. ST, Zip:
Telephone:
State Lic. #
Arch., Engr.. Designer:
Address:
City, ST, Zip:
Telephone:
State
Ltc. #:
Name of Contact Person:
Telephone # of Contact Person:
# Submittal
Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Ftood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE: -
Planning Approval
Pub. Wks. Appr
School Fees
e/�
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City Of La QUintd --
Building 8t Safety Division .
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
BuildingPermit
Application and Tracking Sheet
S . Owner's Name: x
Address: X
vc—
Ciry. ST. Zip: >L, ZAt
STK-t� Telephone:
JZj �T Project Description: X /I.v,
Lic. #:.7 'Z
Total Permit Fees
±MM
Construction Type: P
Occupancy:
Project ect type (circle le one):
New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Estimated Value of Project: x
APPLICANT: DO NOT WRITE BELOW THIS LINE
Ree'd
TRACKING
PERMIT FEES
Plan Check submitted
Item
Amount
Reviewed, ready for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
Mechanical
2"d Review; ready for corrections/issue
Electrical
Called Contact Person
Plumbing
Plans picked up
S.M.I.
Plans resubmitted
Grading
''d Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.1 P P
Date.of permit issue
Total Permit Fees
V
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Certificate,of Occupancy
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O BuBding & Safety Department
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d 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
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provisions of the Building Code and the various ordinances of the City regulating building
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construction and/or use.
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BUILDING ADDRESS: 78-995 Highway 111 Suite 5
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Use classification: Commercial "Happiness Nail Salon" TI Building Permit No.: 05-2852
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Occupancy Group: B Type of Construction: VN Sprinkled Land Use Zone: CR
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Y
Owner of Building: Washington 111 LTD Address: 30240 Rancho Vieio Rd Ste B
City, ST, ZIP: San Juan Capistrano CA 92675
4
By: Daniel P. Crawford Jr.
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Date: 2/27/06
' Building Offi al
POST IN A CONSPICUOUS PLACE --
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