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11-0814 (DEMO)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 a Application Number: Property Address: APN: Application description Property Zoning: Application valuation: e11-0000081 79430 HIGHWAY 111 649 -820 -005 - DEMO - COMML/OTHER REGIONAL COMMERCIAL 0 Architect or Engineer: 1' l P- ------------------ LICENSED CONTRACTOR'S DECLARATION r BUILDING & SAFETY DEPARTMENT BUILDING PERMIT I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 e Busines n of 'onals Code, and my License is in full force and effect. License ass: B License No.: 693.077 e:� z b , om acto OWNER-B,JLDEJRDECLA TION I hereby affirm under penalty of perjury that I am exempt ontra is State License Law for the following reason (Sec. 7031.5, Business and Professions ci r 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 _ 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 contractors) licensed pursuant to the Contractors' State License Law.). (_ 1 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: ' LQPERMIT Owner: DALIP TIBB VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: ' 7/28/1.1 it A Contractor:, ORR BUILDERS 39301 BADGER, SUITE #30 JU 2,)- 20.11 PALM DESERT, CA 92211 1 (760) 360-6632 CITY Of Lic. No.: 693077 !_ rer.1:3..i'A�� 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 1960920-2011 I certify that, in the performance of the work for which this permit is issued, I shall not empldy 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�e L'afS6r6ode Leh3I with comply with those provisions. ate: Z �1 pplica7 WARNING: FAILURE TO SECURE ERS' OMPENSA ON COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE LTIES AND Cl L FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO TH COST OF COM ENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTERE RNEY'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. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relaling4 wilding construction, and hereby authorize representatives of this county to enter upon the above-mentioned grope r inspPoTn purposes. D e: tis $isinature (Applicant or A ent :� Application Number . . . . ::3'. 11-00000814 Permit DEMO PERMIT Additional desc . Permit Fee . . 45.00 Plan'Check Fee .00 Issue Date . . Valuation 0 Expiration Date 1/24/12 Qty Unit Charge Per Extension BASE FEE 45.00 Special Notes and Comments DEMO RESTROOMS IN PREPARATION FOR TENANT IMPROVEMENT. 2010 CODES. Fee summary Charged Paid Credited Due Permit Fee Total 45.00 .00 .00 45.00 Plan Check Total .00 .00 .00 .00 Grand Total 45.00 .00 .00 45.00 LQPERMIT Dalip Tibb M.D. - 51880 Via Roblada La Quinta, CA 92253 July 27, 2011 Building & Safety Department Management City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 RE: Authorization to Perform Demolition Work To Whom It May Concern: This letter is to serve as authorization for Orr Builders to commence demolition work for the property located at 79-430 Highway 111, APN: 600-390-005-7 as outlined on plans by JMS Design dated 07/27/2011. Enclosed please find the grant deed dated July 21, 2011 provided as proof of property ownership. If you have any questions, please contact me at 760-289-6937. Sincer ly, Dalip Tibb Enclosures: (1) Bin # Qty of is nuinta �C Building 8T Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # Project Address: �14�- o I Owner's Name: �' l ( P A. P. Number: (0,00 _ 590 _ bO Address: I d ( Legal Description:' City, ST, Zip: 1-h C,4- g Z Z,53' Contractor- 0 telephone: % 111' Address:( (t 3 Project Description: City, ST, Zip: WM GA 92z(/ Telephone: ;n4k'.v �';iNtill;{{ii4i;:;;i Y•.i:!:. �f:;i:�:y$:�' State Lic. # : City Lic. #.: Arch., Engr.; Designer:? DC515( Address: I(r 0 ,-17v City, ST, Zip: 8J t CA fYzz,5,S ;• n;;Y:y. }'i Telephone: �%% State Lic. #: '`!';µ:.;:•.::>""> a Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: 77 AS SIA lTl� Sq. Ft.: -157-0s: #Storie # Units: Telephone # of Contact Person: —7(08 -9 2 — gZCa 2 Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd 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 Cates. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready for correctionsfissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correctionsfissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees rar 0