09-0308 (RC)r'r
P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
0�0 00-0:308`
Property Address:
IC 77 SANTA ROSA . PLAZA
APN:
770-020-031-6 -000000-
Application description:
REMODEL - COMMERCIAL
Property Zoning:
GOLF COURSE
Application valuation:
6000•
Applicant: Architect or Engineer:
------------------
LICENSED CONTRACTOR'S�6ECLARATION
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
hereby. affirm underpenalty of'perjury, that'l licensedunder provisions of:,Chapter 9 (commencing, with .
Section 7000) of Division 3 of the Business d Peofession ,Code; and my License is in. full force and -effect.
License Class:' B censeWo.: 773968
Da` tem a- fi Contractor:
OWNER B LDER'DECLARATION
I hereby affirm.underpenalty of perjurythat I am exemptfrom the.Contractor's State License Law for the
following reasori•.ISec. 7031.5; Business and Professions Code: Any city oIr 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 orshe is exempt therefrom and the basis f6r the alleged exemption. Any violation of -section 703i.5 by
any applicant for a permit subjects the applicant toa 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
. thee- structureis not intended or:offered for sale (Sec: 7044, Business and Professions Code: The -
- Contractors' State License Law does,noiapply to. an -owner of property whobuildsor improves thereon,
and who does the work himself.or herself through his or her own employees, provided that the
rmproyements}are notintendedor 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 ownerof 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.). .
1 _ 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:
HOSTMARK HOSPITALITY
1111 PLAZA DRIVE
SUITE 200
SCHAUMBURG, IL 60173
Contractor:
CHAMPAGNE TOUCH
77917 WILDCAT DRIVE
PALM DESERT, ,CA 92211
(760)345-6668
Lic.'No-: 773968
.VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/18/09
WORKER'S COMPENSATION DECLARATION
I hereby affirm -under -penalty of perjury one of. the following declarations:
_ I have and will maintain.a certificaie-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' comp- nsationinsurance, as required by Section 3700 of the Labor
Code,'for the performance of the work for which this permit is issued. My iorkers' compensation
insurance carrier and policy*number.are: -
Carrier EXEMPT Policy Number EXEMPT
I certify -that, in theperformance 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 s.hbuld become subje'tcty� the workers' compensation provisions of Section
3700 of, the Labor Co I shall .forthw�tomply. with those provisions.
Dat��C
0 —0�'Applicant:
- WARNING: FAILURE TO SECURE WORKERS' COMPENSA- ON COVERAGE IS UNLAWFUL, AND SHALL -
SUBJECT. AN EMPLOYER TO CRIMINAL PENALTIES'AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS 1$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 the above information is correct. I agree to comply with all
city and county ordinances and state laws relating to building constructs , and hereby authorize representatives
of this county to enter upon the above-mentioned propertyAr inspect purposes.
� q �..
'aDat` e: : /= �r>� � Signature;(P.;pplicant_or Agent): 54
Application Number . . . . . 09-00000308
------ Structure Information RENOVATION TO BREAKFAST BUFFET -----
Other struct info . . . CODE EDITION 2007CBC
FIRE SPRINKLERS FULLY
MIXED-USE OCCUPANCY EXISTING
----------------------------------------------------------------------------
Permit . . . . .
Additional desc . .
Permit Fee . . . .
Issue Date . . . .
Expiration Date . .
BUILDING PERMIT
81.00
3/17/10
Plan Check Fee . . 52.65
Valuation . . . 6000
Qty Unit Charge Per Extension
BASE FEE 45.00
4.00 9.0000.THOU BLDG 2,001-25,000 36.00
----------------------------------------------------------------------------
Permit . . .. ELECT - ADD/ALT/REM
Additional desc .
Permit Fee . . . . 22.50 Plan Check Fee 5.63
_Issue Date Valuation . . . . 0
Expiration Date 3/17/10
Qty Unit Charge Per Extension
BASE FEE 15.00
10.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 7.50
----------------------------------------------------------------------------
Permit . . . . . PLUMBING
Additional desc .
Permit Fee . . . . 24.00
Issue Date . . . .
Expiration Date . . 3/17/10
Plan Check Fee . . 6.00.
Valuation . . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 6.0000 EA PLB FIXTURE 6.00
1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00
----------------------------------------------------------------------------
Special Notes and Comments
RENOVATION TO BREAKFAST BUFFET ONLY.
THIS PERMIT DOES NOT INCLUDE REMODEL TO
ATRIUM AREA AS SHOWN ON SHEET A2.1.
2007 CALIFORNIA BUILDING CODES.
April 10, 2009 3:33:21 PM AORTEGA
-----------'-----------------------------------------------------------------
Other Fees . . . . . . . . . ACCESSIBILITY PLAN REVIEW 5.27
LQPERMIT
i
LQPERMIT
Application Number . . . . . 09-00000308
----------------------------------------------------------------------------
Other Fees . . .
. . . . . .
BLDG STDS
ADMIN (SB1473)
1.00
ENERGY REVIEW
FEE
5.27
Fee summary
-----------------
Charged
----------
Paid
----------
Credited
--------------------
Due
Permit Fee Total
127.50
.00
.00
127.50
Plan Check Total
64.28
.00
.00
64.28
Other Fee Total
11.54
.00
.00
11..54
Grand Total
203.32
.00
.00
203.32
Bin #
0144)
City, of La Quinta..
Build ; ing u Safety Division
P.O. Box. 1504., 78-405 Calle Tampico
La Quinta, CA 92253: 1 (760):777-7012
Building Permit Application and Tracking Sheet
Perit #
Project Address: 56-777 :J,4 4C,4—fi4Zq Owner -'s Name:
A. P. Number: Address: &1 /&-,7
4
Legal Description: City, ST, Zip:
Contractor: c�a:Telephone*: 9q'77's-Al,
Address: "77-11,7 tvop(f,,4.1 R— 0 Project Description:
City, ST, -zip:
Off
Telephone: 76p-3 els - L � Q.
City Lic. #:,
State Lic. #:
Arch., Engr., Designer: A�
Address: )!!a46 LJAq
City, ST, Zip:j44UNA-A
Telephone: 10-5-0 S-10 If 91 Construction Type: Occupancy:
State Lic. #: 4f Project type (circle one): New Add'n Alte Repair Demo
Name of Contact Person: w Sq. Ft.: ?6M5F' 1'#Stofies: # Units:
Telephone # of Contact Person: Estimated Value of Project: 61&ZO
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req!d- -
Recd.
TRACKING,,
PERMI[T FEES
Plan Sets
Plan Check submitted
Item Amount
Structural CaIcs.-
Reviewed, ready for corrections
Plan Check Deposit
Truss Caics.
Called Contact Person
Plan Check Balance
Energy Cates.
Plans bicked up
Construction
Flood plain plan
Plans resubmitted
Mechanical.
Grading plan
2" Review, ready for correctionsrissue
Electrical
Subcoutactor.List
-Called Contact Person
7v
Plumbing
Grant Deed
I Plans picked up
S.M.I.
H.O.A. Approval
I Plans resubmitted
Grading
IN HOUSE:-
Review, ready for c.orrcctil!!!sue
Developer Impact Fee
Planning Approval
Called Contact Person
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees