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08-0192 (RC)P.O. BOX 1504 78-495 CALLE TAMPIC0 LA QUINTA, CALIFORNIA 92253 Application Number: 08-00000192 Property Address: 47647 CALEO BAY STE 200 APN: 643-200-004- - Application description: REMODEL COMMERCIAL Property Zoning: COMMUNITY COMMERCIAL Application valuation: 200000 Applicant: w '�//'��� Architect or Engineer: LICENSED CONTRACTOR'S DECLARATION 1 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 of the Busines and Pr fessionaI Code, and my License is in full force and effect. License Class: B LicenseNo.: 693077 ,p Date: � Contractor: � vOl OWNER-BUI DER 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 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 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.). am exempt under Sec. , BAP.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: LA QUINTA MEDICAL PARTNERSHIP 5500 TRABUCO RD 4100 IRVINE, CA 92620 Contract(.:�69 n ORR BUS 39301 R, SUITE 4300 PALM D, �G'�Af' 2�- 2Q0�3 (760)3632 Lic. N CIMIA F LA QUINTA VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/02/08 ------------------------------------------- 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 756-0000335-07 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 /1 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: G .2 G Applicant: 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 application and state that thevabove information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, d hereby authorize representatives of this coun y to rater upon the -above-mentioned property for ' ection p poses. Date: G e/ Signature (Applicant or Agent): LQPERMIT Application Number . . . . . 08-00000192 ------ Structure Information 5,771SF TI/V-B/B-OCC/72-OL/SPRINKLED ----- Other struct info . . . CODE EDITION 2007CBSC FIRE SPRINKLERS FULLY MIXED-USE OCCUPANCY B OCCUPANT LOAD 72.00 ---=-------------------------=---------------------------------------------- 1ST FLOOR SQUARE FOOTAGE 5771.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee 989.50 Plan Check Fee 643.18 Issue Date . . . . Valuation . . . . 200000 Expiration Date 11/29/08 Qty Unit Charge Per Extension BASE FEE 639.50 100.00 3.5000 ---------------------------------------------------------------------------- THOU BLDG 100,001-500,.000 350.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 130.42 Plan Check Fee 32.61 Issue Date Valuation . . . . 0 Expiration Date 11/29/08 Qty Unit Charge Per Extension BASE FEE 15.00 5771.00 .0200 ---------------------------------------------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL 115.42 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 127.50 Plan Check Fee 31.88 Issue Date . I. . . -Valuation . . . . 0 Expiration Date... 11/29/08 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5000 EA MECH VENT INST/ DUCT ALT 4.50 3.00 16.5000 EA* MECH B/C >3-15HP/>100K-500KBTU 49.50 3.00 6.5000 EA MECH AH <=10K CFM 19.50 6.00 6.5000 ---------------------------------------------------------------------------- EA MECH VENT FAN 39.00 Permit . . . PLUMBING Additional desc . Permit.Fee . . . . 175.50 Plan Check Fee 43.88 LQPERMIT ,'Application Number . . . . . 08-00000192 Permit . . . . . . PLUMBING Issue Date Valuation . . . . 0 Expiration Date 11/29/08 Qty Unit Charge Per Extension BASE FEE 15.00 25.00 6.0000 EA PLB FIXTURE 150.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50 -1.•00 3.0000 EA PLB WATER INST/ALT/REP 3.00 ---------------------------------------------------------------------------- Special Notes and Comments 5,771SF TENANT IMPROVEMENT/V-B/B-OCC/72- OCCUPANT LOAD/FULLY SPRINKLED. [JFK ORTHOPEDIC CENTER) THIS PERMIT DOES NOT INCLUDE BUILDING SIGNAGE. 2007 CALIFORNIA BUILDING STANDARDS. June 2, 2008 9:06:48 AM AORTEGA ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ACCESSIBILITY PLAN REVIEW 64.32 ENERGY REVIEW FEE 64.32 STRONG MOTION (SMI) - COM 42.00 Fee summary Charged Paid Credited ----------------------------------------------- ---------- Due Permit Fee Total 1422.92 .00 .00 1422.92 Plan Check Total 751.55 .00 .00 751.55 Other Fee Total 170.64 .00 .00 170.64 Grand Total 2345.11 .00 .00 2345.11 LQPERMIT Bin City of La Quinta Building U 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: #7 (! c`7 4:5 9.I� p 434AQ Owner.'s Name: JjCK 441,Xp91*– /?Siff T A. P. Number: sv171_`ZD°O'1 ' Address: y7. /I ^0N&'>0ra ST' Legal Description: City, ST, Zip: l/VD/O Contractor: aR12- 8U/4.jD0_/LS Telephone: 7�0 77f .oFW9 Address: 3 B/f D4 6'2 s T S� 300 Project Description: City, ST, Zip: /94�r !7C SCK T Go CFZ?– Z /! s" 7 7 Telephone:,%�(v 0 2S� y/G L: !%V7�2�- State Lic. # : 9 3 o 7 7 City Lic. #: Arch., Engr., Designer: IALT G ! ` f. TU Address: 70 M_ IA16#w4y !// r�1� 1�. A y gun y ` v City, ST, Zip: 2A/VC1yG q1Rh&4_ Cti" 92Z70 Telephone: P 7G0 32 $ S Z �� State Lie. #: 6.17. 7 I(- Name of Contact Person: Gey tv �� v T e: Construction Type: iZ � Occupancy: . Project type (circle one): New. dd'n)Alter Repair Demo Sq. Ft.: S"7 7 I # Stories:. Z #Units: / Telephone # of Contact Person:�p 28 S. ZOO Estimated Value of Project: C700 APPLICANT: DO NOT WRITE BELOW THIS LINE . # Submittal Req'd Recd TRACMG . PERMIT FEES, Plan Sets Plan Check submitted 2 Item Amount Structural Coles. Reviewed, ready for corrections Plan Check Deposit Truss Coles. Called Contact Person $ Plan Check Balance Energy.Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading. plan'2°" Review, read correct' e Ce Electrical Subcontactor List Called'Contact Person Plumbing Grant Deed Plans. picked up S.M.I. H:O.A. Approval Plans resubmitted Grading IN HOUSE:- '.'d Review, ready for correcti sfissue 2 DU Developer Impact Fee Planning Approval Called Contact PersonI.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees �eq4-� �, b��ara� �tw ILU� �u6l ,- Certificate of Occupancy- 4 c� OF�w Building & Safety Department This Certificate is issued pursuant to the requirements of Appendix Chapter 1 Section 110 of the 2007 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: 47-647 CALEO BAY STE #200 Use classification: COMMERICAL (JFK ORTHOPEDIC CENTER Building Permit No.: 08-192 Occupancy Group: B Type of Construction: V-B Land Use Zone: CC Sprinklers Installed: YES Sprinklers Required: YES Occupant Load: 72 Owner of Building: LA QUINTA MED PARTNERSHIP Address: 5500 TRABUCO RD # 100 City, ST, ZIP: IRVINE, CA 92620 By: STEVE TRAXEL Building Official Date: OCTOBER 9, 2008 POST IN A CONSPICUOUS PLACE ILU� �u6l