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04-6552 (RC)P.O. Box 1504. 78-495 CALLE TAMPIC.O LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING &SAFETY DEPARTMENT (760),777-.7012 'FAX (760) 777-7011 INSPECTION,REQUESTS: (760).777-2153 Application Number 04-00006552 Date 9/30/04 Property Address 79375 HIGHWAY 111 APN: 649-030-999-5 -3042'0. - Application description REMODEL - COMMERCIAL ��-- Property Zoning REGIONAL COMMERCIAL Application valuation 7000 OCT . �.. 2��... Owner Contractor CITY OF LA QUINTA lw0 ------------- ---------------------.-=---- FIF�_ANC_T. STAMKO DEV CO STAMKO DEVELOPMENT-COMPANY-- C10. EVELOPMENT COMPANY'C/O. PROVIDENT FINANCIAL MGMT 3.856 VIA .DOLCE 1034.5 W OLYMPIC BLVD 2 FL.. MARINA DEL REY .'CA :90292 LOS ANGELES 'CA `900.64 (310) .789-5288 WCC:. STATE'. FUND WC:. 1557214 05•/01/05 CSLB 762799 05/31/05 CCC A -- Structure Information 2 1/.2 TON A/C ADDITION.. Construction Type TYPE V - NON RATED .Occupancy Type MERCANTILE Flood Zone NON-AO.FLOOD ZONE.' Other struct info "CODE EDITION' 2001 CBC FIRE. -SPRINKLERS: ' YES . ,. Permit ..BUILDING PERMIT. Additional .desc. Permit' Fee .90-.00. Plan Check F.ee 5:8.50 Issue Date Valuation 700.0 Expiration Date 3/28/05. Qty` Unit Chargee Per. Extension BASE FEE 45.00 5.00 9.0000 THOU BLDG.2,001-25,000 45.00 7-77 Permit . . . . . ELECT.-'ADD/ALT/REM Additional desc Permit Fee 16.50 Plan Check.Fee 4..13 Issue Date Valuation 0 Expiration. Date 3/28/-05.. Qty ..-Unit Charge Per.. Extension BASE FEE 15.00 2.00......17.500 --PER ELEC DEVICE/FIXTURE 1ST 2'0 1..50 P.O. Box 1504 VOICE -'(.7100) 777-701-2 78-495 CALLE TAMPICO FAX (760) 777-7011. LA QUiNTA, CALIFORNIA 92253 INSPECTIONS (760)'777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Date: Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: Lic. No.: 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 License is,jA4ull force and effect License Class License No..-fti Datelt �y Contractor r T OWNER43 ER DECLARATION I hereby affir 'under penalty of perjury that I am exempt from the Contractors`, 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 stricture, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is ficensed 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 cM1 penally of not more than five hundred dollars ($500).): l, 'as 1as 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'hnprovements are not Intended or offered for sale. If, however; the binding or improvement is sold within one year of completion, the owner -builder will have Ore 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 contactor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. B.3 P.C. for this reason Owner WORKERS' COMPENSATION DECLARATION 1 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 whictm this permit is Issued.- Mtivers' compermsation insurance carrier and iumber ale: Carrier �T� ` Fym�I1D Policy Number (� 7_1 r. ) _ 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, l shall forthwith comply with those provisions. . • t Date Appficant r r f 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. CONSTRUCTION LENDING AGENCY .I hereby affirm under penalty of perjury that there is a construction lending agency for the,perfomnance of the work for which this permit Is issued (Sec. 3097, CN. C.). Lenders 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. 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 18o 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 afi city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-m6ntioned property for inspection purposes. •:.Signature (Applicant or Agent): :-r L f Page 2 Application Number . . . . . 04-00006552 Date 9/30/04 --------------.--------=----------------------------------------------------- Permit MECHANICAL Additional desc . Permit Fee . . . . 33.00 Plan Check Fee 8.25 Issue Date . . . . Valuation• . . . . 0 Expiration Date 3/28/05 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 ------------------------------------------------------------------7--------- 9.00 Permit PLUMBING Additional desc Permit Fee . . . . 18.00 Plan Check Fee 4.50 Issue Date . . . . Valuation 0 Expiration Date 3/28/05 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS ----------------------------------------------------------------------------- 3.00 Special Notes and Comments addition of a 2 1/2 ton a/c unit.PERMIT CARD WILL NOT BE ISSUED, INSPECTION SHALL BE MARKED ON EXISTING INSPECTION CARD. Fee summary Charged Paid Credited ----------------- Due -=---------------------------- Permit Fee Total 157.50 .00 .00 ---------- 157.50 Plan Check Total 75.38 .00 .00 75.38 Grand Total 232.88. .00 .00 232.88