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14-0600 (RC)�IGf�h,1�iV P.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 BUILDING PERMIT Date: 5/13/14 Application Number: 14-00000600 Owner: Property Address: 79410 HIGHWAY 111 STE 104 KLEINE NEIL WAYNE "---� APN: 649-820-006- - - e� Application valuation: 4500 AY HH Zg9f{ Contractor: Applicant: Architect or Engineer: EDWARDS CONSTRUCTION C, B �ND yv�— WTD�_/I 51455 DESERT CLUB DRIVE LA QUINTA, CA 92253 (760)777-8202 LiC. No.: 684857 ------------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the B4 ' s na`LijeneV.: Prof nd my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License las B C27 848 7 — for by Section 3700 of the Labor Code, for the performance of the work for which this permit is ,( issued. .` /Date. Contractor: til/ �+' I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor x Code, for the performance of the work for which this permit is issued. My workers' compensation 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 _ 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 1 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: .. LQPERMIT insurance carrier and policy number are: Carrier BENCHMARK INS Policy Number CST5003510 I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner as b e subject to the workers' compensation laws of California, / and agree 'hat, if Iso d b c e s j to the workers' co pensation provisions of Section I,� 00 of the Labor t comply with rhos provisions. 'Date• (4_ Applicant: 1. 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 ($100,0001. 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 beco es null and void if work is not commenced within 180 days from date of issuance of such er �t, or ssation of work for 180 days will subject permit to cancellation, f certify that I have read this application and state that the ov in rmation is orrect. I agree to mply with all city and count ordinances and state laws relating to b i c rs uction, an I ereby authorizer resentatives of thisCcol//�� my1/1F a ter upon the above-mentioned pro y for sp ti purp es. Date:✓It "I ' Signature (Applicant or Agent): ti Application Number . . 14-00000600 Permit . . . ELECTRICAL 2013 Additional desc . . Permit Fee . . . . 23.83 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/09/14 Qty Unit Charge Per Extension 1.00 23.8300 LS ELEC FIXTURES, FIRST 20 23.83 ------------------------- --------------------------------------------------- Permit . . . PLUMBING 2013 Additional desc . Permit Fee . . . . 23.84 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/09/14 Qty Unit Charge Per Extension 1.00 11.9200 EA PLBG FIXTURE/TRAP 11.92 1.00 11.9200 EA PLBG WATER INST/ALT/REP ------------------------------=---------7----------------------------------- 11.92 Permit . . . REMODEL 2013 Additional desc . Permit Fee . . . . 120.12 Plan Check Fee .00 Issue Date Valuation . . 0 Expiration Date 11/09/14 Qty Unit Charge Per Extension 1.00 71.5000 EA MISC PARTITION 71.50 1.00 48.6200 LS MISC REMODEL, 1ST 100 SF 48.62 ---------------------------------------------------------------------------- Special Notes and Comments REPLACE WALL & TUB THAT WAS REMOVED BY PREVIOUS DOG GROOMER TENANT May 9, 2014 1:34:35.PM jjohnson. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 PLAN CHECK,, ELECTRICAL 23.83 PLAN CHECK, REMODEL 264.55 PLAN CHECK, PLUMBING 23.84 STRONG MOTION (SMI) - COM .95 Fee summary Charged Paid Credited Due --------------------------------------------------------- Permit Fee Total.. 167.79 .00 .00 167.79 Plan Check Total .00 .00 .00 .00 Other Fee Total 314.17 .00 .00 314.17 LQPERMIT r� , Application Number . . . . . 14-00000600 Grand Total 481.96 .00 .00 481.96 Bin # City of La Q uin to Building 8i: Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Per it # l� Project Address: g - Gt (� %/ Te- Owner's Name: �7T I &f —�Co � 4 A. P. Number: t�Z� 5_� —C?) Address: —79 ( Cj(' I it-lt4 Legal Description: `.4 Lt/ C,eV-11I, of: t4 Z9 "F2 s`>- City, ST, Zip: L4L Z�U lam. r- Contractor: �i J C'J( Telephone: —7? 7 �J 2�� >>»>'_€ %s`•.`>?; Address: Project Description: City, ST, Zip:`/ Telephone: � WAS✓ l (Q�5 State Lic. # : City Lemic. #: ( '� ,r., Designer: ' ..o Address: % 74 �Z eC5Us�tAK' GLOO; City, ST, Zip: . Lt � T Telephone:6 ��•i':•:ii:�:.i::i :U ` "<'<' " >' •^°" ":>:>:•::•:.::•<»:::•>.:; <'s>:<, Constru ction Type: Occupancy: State Lic. #: Project type circle one): New Add'n Alter RepairDemo Name of Contact Person:7 6Q k::, � % . Sq. Ft.: # Stories: �' # Units: Telephone # of Contact Person: Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2°" Review, ready for correction/issue S Electrical Subcontactor List Called Contact Person S Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees + V 6 W;5&660A- Cop y