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11-0178 (RC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: I -00000178 Property Address: 79395 HIGHWAY 111 APN: 649-030-999-5 -30420 - Application description: REMODEL - COMMERCIAL Property Zoning: REGIONAL COMMERCIAL Application valuation: 45000 Applicant: Ce 1rft%C-_M iZ (f -4 4 4Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Architect or Engineer: �2!T10 r <51. at a. 32.7 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury at I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Bu ss and Professiofals Code, and my License is in full force and effect. License lass: B C36 "seNo.: 502381 Date1 1!V1 I N Contractor: E 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 ($500).: (_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the. improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). 1 _) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). ( ) I am exempt under Sec. , B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY ' I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPEPAIIT VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: STAMKO DEV CO C/O PROVIDENT FINANCIAL MGMT 10345 W OLYMPIC BLVD 2 FL LOS ANGELES, CA 9006 kN Contractor: i GLUCK DEVELOPMENT CO ?MAR 291 26901.AGOURA ROAD STfEfAGOURA HILLS, CA 913$ (818) 880-8220 CRY OF�,AQUIN1 Lic. No.: 502381 r�nr�<�4.� �� Date: 3/07/11 III 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 0000155-2010 I certify that, in the performance of. the work for which this permit is issued, I shall not employ any person in any manne o as to become subject to the workers' compensation laws of California, and agree that, if I s o Id become subject to the workers' compensation provisions of Section 3700 of the Labor o , I sh fo o ply with those provisions. ate: ]qf( pplicant. 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, or cessation of work for 180 days will subject permit to cancellation. I certify that I,have read this applicationand state that th bove information is correct. I agree to comply with all city and county ordinances and state laws relating to bu' di g construction, and hereby authorize representatives of this c unty to enter upon the above-mentioned prop t for irri�, s ec I 2 ' Dat e✓ I� ( 4nature (Applicant or Agent): `-' Application Number . . . . . 11-00000178 Structure Information Construction Type . . . . . TYPE V, UNPROTECTED Occupancy Type . . . . . MERCANTILE Other struct info . . . . . CODE EDITION 2010 CBC FIRE SPRINKLERS YES ---------------------------------------------------------------------------- Permit . Additional desc Permit Fee Issue Date Expiration Date BUILDING PERMIT 382.00 9/03/11 Plan Check Fee . . 248.30 Valuation . . . . 45000 Qty Unit Charge Per Extension BASE FEE 252.00 20.00 6.5000 ---------------------------------------------------------------------------- THOU BLDG 25,001-50,000 130.00 Permit . . . ELECT - ADD/ALT/REM .Additional desc . Permit Fee 36.30 Plan Check Fee 9.08 Issue Date Valuation 0 Expiration Date 9/03/11 Qty Unit Charge Per Extension BASE FEE 15.00 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST.20 15.00 14.00 .4500 ---------------------------------------------------------------------------- EA ELEC DEVICE/FIXTURE >20 6.30 Permit . . . MECHANICAL Additional desc . Permit Fee. . . 26.00 Plan Check Fee 6.50 Issue Date . . . Valuation . . . . 0 Expiration Date 9/03/11 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 1.00 6.5000 EA MECH.VENT FAN 6.50 ---------------------------------------------------------------------------- Special Notes and Comments REMODEL OF ENTRY DOORS, CHECKSTANDS, DRESSING ROOM AND ADD IT ROOM TO EXISTING ELECTRICAL SERVICE ROOM. [TENANT: MARSHALLS - TJX COMPANIES] 2010 CODES. "M" OCCUPANCY, TYPE V -B LQPERIMIT Application Number . . . .. . 11-00000178 ---------------------------------------------------------------------------- Special Notes and Comments CONSTRUCTION. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ACCESSIBILITY PLAN REVIEW 24.83 BLDG STDS ADMIN (SB1473) 2.00 ENERGY REVIEW FEE 24.83 STRONG MOTION (SMI) - COM 9.45 Fee summary Charged ---------- Paid -------------------- Credited ---------- Due ----------------- Permit Fee Total 444.30 .00. .00 444.30 Plan Check Total 263.88 .00 .00 263.88 Other Fee Total 61.11 .00 .00 61.11 Grand Total 769.29 .00 .00 769.29'