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04-4728 (RC)T-Vf 4 4 a" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . 04._090.04728' Date Property Address . . . . 79405 HIGHWAY 111 STE 12 APN: 649-030-999-6 . -30420 - Application description . . . REMODEL - COMMERCIAL Property Zoning . . . . REGIONAL COMMERCIAL Application valuation 3500 Owner STAMKO DEV CO C/O PROVIDENT FINANCIAL MGMT 10345 W OLYMPIC BLVD 2 FL LOS ANGELES CA 90064 Contractor 6/04/04 MARTINOVICH, GEORGE.", DBA MRVT 78750 SAINT THOMAS DRIVE INDIO CA 92203 (760) 360-5251 Qty Unit Charge Per JUN 4 2004Extension BASE FEE 9 CITY OF ;, __ UNTA � 5.00 20.00 . 7500 PER ELEC DEVICE/FIXTURE 1ST 21'OA _uEDEPT 5.00 3.00 .4500 EA ELEC DEVICE/FIXTURE >20 . 1.35 WCC: EXEMPT WC: EXEMPT 06/30/05 CSLB: 466671 06/30/06 CCC: B -------------------------- Structure Information ------------------------- Construction Type . . . . . TYPE'V - NON RATED Occupancy Type . . . . . . MERCANTILE Other struct info . . . . . CODE EDITION 2001 FIRE SPRINKLERS YES OCCUPANT LOAD 77.00 - ---------------------------------------------------------------------------- FIRST FLOOR SQ FTG 3815.00 Permit . . . . BUILDING PERMIT Additional desc Permit Fee . . . . 63.00 ,--=Plan Check Fee 40.95 Issue Date . . . . - .� - uation . . . . .. 3500 _Val \ Qty Unit ChargeV Per Extension BASE FEE 45.00 2.00 9.0000 ------------------------------------------.-------------------------------- THOU BLDG 2,001-25,000 18.00 Permit . . . . . . ELECT - ADD/ALT/REM Additional desc Permit Fee . . . . � 31.35 Plan Check Fee 7.84 Issue Date . . . . Valuatilo'n" p Qty Unit Charge Per JUN 4 2004Extension BASE FEE 9 CITY OF ;, __ UNTA � 5.00 20.00 . 7500 PER ELEC DEVICE/FIXTURE 1ST 21'OA _uEDEPT 5.00 3.00 .4500 EA ELEC DEVICE/FIXTURE >20 . 1.35 P.O. BOX 1504 78-495 CALLE TAMPICO 4. A QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Applicant: Applicant's Mal Ing Address: Am, L V 1111F VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: Architec gineer: 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 isII force and effect. / License Class License Date v G OWNER -BUILDER DECLARATION I hereby affirm 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 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).): U 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 contractor(s) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , BA P.C. for this reason Date WORKERS' 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: Cartier Policy Number I cerfify 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, I shall forthwith comply with those provisions. �1 Date b "U Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO C IMINAL 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 Lenders Name ;f7ury that there is a construction lI hereby affirm under penaltyending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lenders 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 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 ith all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the abov n ioned pro y for inspection purposes. el - Date' 6tiL ' G Signature (Applicant or Agent): amu.. f1 4 Page 2 Application Number . . . . . 04-00004728 Date 6/04/04 ---------------------------------------------------------------------------- Special Notes and Comments Commercial Remodel (W. Simmons Mattress TI) 3815 s.f. "M" Occupancy, Type VN Sprinkled, Occupant Load 77 --7 ------------------------------------------------------------------------- Other Fees . . . . STRONG MOTION (SMI) - COM .73 Fee`summary* Charged Paid Credited Due -- - - - - - - - - - - - - - -- Permit Fee Total ---- - - - - -- 94.35 ---- - - - - --- .00 --- - - - - -- .00 ---- - - - - - - 94.35 Plan Check Total 48.79 .00 .00 48.79 Other Fee Total .73 .00 .00 .73 - Grand Total 143.87 .00 .00 143.87 4 CITY OF LA QUINTA SUB -CONTRACTOR LIST 0�1 JOB AQDRESS f' b� /ll �� PERMIT NUMBER _ OWNER h�•�fN S� 44po^j BUILDER�� y��4/tl•� o )/*,r.�t%�'e�- This form shall be posted on the j b with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employe are authorized to work on this job. Any changes to this list must be approved by the Building Division prior tocommencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. c..l.a.s bs.c � :.:.::.::.::.:..::.::.... _�..::.::.:..:.::.:.S....t.a...�..e.....;....a....n..t..r.........o..r.....s.... .t..:.,.o..e...n..s. .............aet:..:.. ;.:..:.;.:..;. :..;.::..;.;.:.i..: ........................................................V. ..C. i.:...........,:..................................1..o...t..k..e...r. �...o..m.... .. Ca..�.n.....D.....t..e �.. Ia...n...c..e..:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:...:. .;............B...t.t.s...s.....E..x. ..e...r.t.s...a..t.A" mot sifcationL'censeNumberEx (e.g. AB C8) (xxxxxx1 ate. xx xx/xx1 Carrier NamePolicy e.9 State Fund, CaIComP1 ormatVaries1 Exp.DateL'cense Numb.e...r. xx/xz xx1 1xxxx P.. Date xx/xx xx.1 r r s ,-.30 �+ J o G 0 Z / 20 0 C� P O l� iW .Q. 1PtX-"-:-:: .. . . ........ .0 1 ...... o 3 .1 t�1 c. N � v v O o o 3 O i � / O' f.. - O i+Jul'' 7 NLL m O J' O Z ::����•::.i•:!::ivv:?i:•:{v�i�•:i•ii?iiiiii:•ii:: is iii ' - l ��r ::s'.�'���rAPC ........�y��A�� �:•:4iiii' i F`It.:NT1.l �C #x ✓ �r y of G1 �. :: License Detail http://www2.csib.ca.gov/USLt3—LWEARY/License+i)etau.asT License Detail GALIWKNIA WT! I KAG I VKb 51 A 1 t L1L;rNQ1-- CIVAKU Contractor License S 46WI DISCLAIMER . A license status check provides information taken from the CSLB license data base. Before relying on this information, you should be aware of the following limitations: • CSLB complaint disclosure is restricted by law (B&P 7124.6). If this entity is subject to public complaint disclosure, an icon will appear below. Click on the icon to obtain additional complaint information. • Per B&P 7071.17, only construction related civil judgments known to the CSLB are disclosed. is • Arbitrations are not listed unless the contractor fails to comply with the terms of the arbitration. • Due to workload, there may be relevant information that has not yet been entered onto the Board's license data base. Extract Date: 05/27/2003 * * * Business Information * * * GEORGE MARTINOVICH JR DBA MARVEST 78-750 SAINT THOMAS DRIVE BERMUDA DUNES, CA 92201 Business Phone Number: (760) 360-5251 Entity: Sole Ownership Issue Date: 12/05/1984 Expire Date: 06/30/2004 * * * License Status * * * This license is current and active. All information below should be reviewed. * * * Classifications * * * _..-..—........... _.._ _... _. _............ Class: Description B GENERAL BUILDING CONTRACTOR * * * Bonding Information * * * CONTRACTOR'S BOND: This license filed Contractor's Bond number 1032709 in the amount of $7,500 with the bonding company SURETY COMPANY OF THE PACIFIC. Effective Date: 06/0112002 Contractors Bonding History * * * Workers Compensation Information * * * This license is exempt from having workers compensation insurance; they certified that they have no employees at this time. Effective Date: 09/16/1991 Expire Date: None Personnel List /, - 1 of 2 05/27/2003 5:33 Pb Tom Tisdale Fire Chief Proudly serving the Unincorporated Areas of Riverside County and the Cities of: Banning Beaumont Calimesa Canyon Lake .. Coachella .;. Desert Hot Springs Indian Wells .;. Indio Lake Elsinore - La Quinta Moreno Valley Palm Desert Perris Rancho Mirage San Jacinto Temecula Board of Supervisors Bob Buster, District 1 John Tavaglione, District 2 Jim Venable, District 3 Roy Wilson, District 4 Marion Ashley, District 5 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 210 West San Jacinto Avenue • Perris, California 92570 • (909) 940-6900. Fax (909) 940-6910 i July 2 , "lUU4 City of La Quinta Building Department Re: Fire Life Safety Clearance The Riverside County Dept Department is granting a fire and life safety clearance For the following project WX.Simmons_Mattress located atUY405-'Hwy-111,1 CSte_#,11L7a.Quinta. NS/jl By Neal Stephenson Fire Systems Inspector EMERGENCY SERVICES DIVISION • PLANNING SECTION . INDIO OFFICE 82-675 Highway 111, 2nd FI., Indio, CA 92201 . (760) 863-8886 • Fax (760) 863-7072 Certificate of Occupancy Twqk 4 4aamrw Building & Safety Department 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 provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 79-405 Highway 111 Suite 12 Use classification: Commercial (W. Simmons Mattress TI) Occupancy Group: M Owner of Building: Stamko Dev. Co. 30 Day Temporary Certificate of Occupancy 77-,t, ZA2�� Building Official Type of Construction: VN 19 Building Permit No.: 04-4728 Land Use Zone: CR Address: 10345 W Olympic Blvd 2 FL City, ST, ZIP: Los Angeles, CA 90064 POST IN A CONSPICUOUS. PLACE By: Daniel P. Crawford Jr. Date: Expires 8/8/04 (Temporary)