BCOM2014-1007r -
78-495 CALLE TAMPICO D Q.�iQum& VOICE (760) 777-7125
LA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/15/2014
Application Number: BCOM2014-1007 Owner: S
Property Address: 77975 CALLE TAMPICO DAVID DORN
APN: 773078028P � P 0 BOX 480 Z 3>
Application Description: SHELL IMPROVEMENT FOR FUTURE TI lam- t LA QUINTA, CA 92253 0 � ,�-�
Property Zonirig: `� --- F. ^ 1 rn 0 �.
Application Valuation: $25,000.00 rn S Cn
oD o
rn
Applicant: Contractor: v
DAVID DORN ` ELLIOTT CONSTRUCTION IN &A
P O BOX 480 �Z .64085 OLYMPIC MOUNTAIN —zmi C
LA QUINTA, CA 92253 DESERT HOT SPRINGS, CA 9
(760)250-5934
Llc. No.: 529207
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 Professions Code,
and my License is in full force and effect..
License Class: B, C27, C53 License No.: 529207
Date: ��i Contractor:/ _
tr
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).:
(_) 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.).
(_) 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. 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:
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 t906-01'0f"of
r which this permit is issued.
ave and will maintain workers' compensation insurance, as required by
Sec 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:_ Policy Number: _
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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date - lfs l Applicant:
.0/40V
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 Building Official 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. 1
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
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date:'% J^ . Signature (Applicant or Agent) ,
'"DESCRIPTION
FINANCIAL INFORMATION
�.F:A000.UNT -QTY_ ' AMOUNT PAID z
PAID DATE
BSAS SB1473 FEE
101-0000-20306 0
$1.00 $0.00
PAID BY
METHOD RECEIPT # ' ^ CHECK #
CLTD BY-.
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00 $0.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT,
�R .,PAID
PAID, DATE
DEVICES, FIRST 20
101-0000-42403
0
$23.83
$0.00
s ',PAID BY;, ° "
METHOD ,"
'� RECEIPT# ...
CHECK#
"CLTD BY "
;. DESCRIPTION :w :.
.`ACCOUNT' ,.
QTY
,.: "AMOU.NT .,
PAID,.
PAID DATE
DEVICES, FIRST 20 PC
101-0000-42600
0
$23.83
$0.00
"" PAZZYI
METHOD
:'.-RECEIPT:# " " `
CHECK #
CLTD BY_
Total Paid for ELECTRICAL: $47.66 $0.00
DESCRIPTION
ACCOUNT
';AMOUNT u"`
y `" ri PAID
PAID DATE
VENT FAN
101-0000-42402
0
$23.84
$0.00
PAID,BY
METHOD
RECEIPT #
CHECK #•:- '
;CtTD BY.
DESCRIPTION ' ', , `. ;,
ACCOUNT ;.. r:
QTY
.; r AMOUNT,.,'
3 rPAID �
PAID DATE
VENT FAN PC
101-0000-42600
0
$9.54
$0.00
" PAID BY
METHOD ' `
RECEIPT # "'
w`,f CHECK #
CLTD.BY
Total Paid for MECHANICAL: $33.38 $0.00 ,
`DESCRIPTION:: -; "-
,.ACCOUNT °' ,'
QTY
AMOUNT
PAID
PAID DATE
WATER HEATER/VENT
101-0000-42401
0
$11.92
$0.00
AID BY,
^+4 - METHOD.
', RECEIPT # , . , ,
iCHECK # _
CLTD, BY .'
—DESCRIPTION r
.` ACC QUNT tF'r,
QTY
A MOUNT
t D 3,�
PAI
'PAID.DATE'
WATER HEATER/VENT PC
101-0000-42600
0
$7.15
$0.00
r 3 PAID BY.,
',`METHOD'RECEIPT
#
CHECK # �`�
� CLTD BY
Total Paid for PLUMBING FEES: $19.07 $0:00
DESCRIPTION
:`r :'ACCOUNT
`QTY
'y AMOUNT° .
- PAID ;'
PAID DATE
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$300.30
$0.00
' PAID BY'METHOD
RECEIPT # ,
�'`i' CHECK # �
''CLTD BY '
i
DESCRIP,TION'" } '^- - ,�
' .ACCOUNT '`
QTY
{`' AMOUNT,:-
PAID , �?K
PAID.DATE
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$240.24
$0.00
s
METHOD
RECEIPT #
CHECK
CLTD BY =.PAID•B
';DESCRIPTION , �`''`
n ,_
a-
ACCOUNT,QTY'
AMOUNT
_ +PAID, a �a
aPAID DAT
REMODEL, FIRST 100 SF
101-0000-42400.
0
$48.62
$0.00
j .,. PAID.BYr�"r
;
^'� RECEIPT# ash'
't CHECK#
`�CLTDBYE:;
DESCRIPTIONS' t"
' ACCOUNT' ,"
rQTY
AMOUNT ''+-
PAID
PAID DATE:
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$132.99
$0.00
'
l :, METHOD hr
.�r a RECEIPT #+ F +
xi-
': CHECK #.4
CLTO BY�'
Total Paid forREMODEL:_ $722.15 $0.00
DESCRIPTION �t �s
;'• +' ACCOUNT
QTY
: AMOUNT '�
PAID f4`
PAID DATE'
SMI - COMMERCIAL
101-0000-20308
0
$5.25
$0.00
. PAID BY - ��" «",
" ';METHOD + `
,� -RECEIPT # a z, }
�e >- CHECK #
YCLTD'BY
Total Paid forSTRONG MOTION INSTRUMENTATION SMI $5.25 $0.00
TOTALS:
r
i
'
9
t
Description: SHELL IMPROVEMENT FOR FUTURE TI
Type: BUILDING, COMMERCIAL Subtype: REMODEL
Status: APPROVED
Applied: 7/14/2014 KHE
Approved: 7/22/2014 JJO
Parcel No: 773078028 Site Address: 77975 CALLE TAMPICO LA QUINTA,CA 92253
Subdivision: SANTA CARMELITA AT VALE LA QUINTA Block: 122
Lot: 4
Issued:\
NO 14
Lot Sq Ft: 0 Building Sq Ft: 0
Zoning:
Finaled:
Valuation: $25,000.00 Occupancy Type:
Construction Type:
Expired:
No. Buildings: 0 No. Stories: 0
No. Unites: 0
Details: A SHELL IMPROVEMENT -LESSEE TO PULL FUTURE TI BASED ON PROPOSED USE
no expansion, remaining retail
ADDITIONAL SITES
CHRONOLOGY
' CONDITIONS - — -- — — --- _ a —
Printed: Friday, August 15, 2014 10:51:31 AM 1 of 3 w CRCYSTFAdC
'DESCRIPTION
ACCOUNT
CITY:
AMOUNT
-PAID,
PAID DATE'
RECEIPT # ,
`CHECK #
METHOD
PAID BY,
CLTD
BY..
a-
e
DEVICES, FIRST 20
101-0000-42403
0
$23.83
$0.00
DEVICES, FIRST 20 PC
101-0000-42600
0
$23.83
$0.00
Total Paid for ELECTRICAL: $47.66 $0.00
VENT FAN
101-0000-42402
0
$23.84
$0.00
VENT FAN PC _
101-0000-42600
0
$9.54
$0.00
'Total Paid forMECHANICAL: $33.38 $0.00
WATER HEATER/VENT
101-0000-42401
0
$11.92
$0.00
WATER HEATER/VENT`
101-0000-42600
0
$7.15
$0.00
PC
Total Paid for PLUMBING FEES: $19.07 $0.00
REMODEL, EA
101-0000-42400
0
$300.30
$0.00
ADDITIONAL 500 SF
'
REMODEL, EA
101-0000-42600
0
$240.24
$0.00
ADDITIONAL 500 SF PC
REMODEL, FIRST 100 SF
101-0000-42400
0
$48.62
$0.00
REMODELFIRST 500 SF
101-0000-42600
0
$132.99
$0.00
.PC
'
,
Total Paid for REMODEL: $722.15 $0.00'
SMI -COMMERCIAL
101-0000-20308
0
$5.25
$0.00
Total Paid forSTRONG MOTION INSTRUMENTATION SMt $5.25 $0.00
• •0
INSPECTIONS r
..PARENT PROJECTS .
Printed: Friday, August 15, 2014 10:51:31 AM 2 of 3
" JTSYSTEMS
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MPe1smit3D.etails s .NX, u}:w PERMIT NUMBER
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-
`. _ BOND INFORMATION.:
ATTACHMENTS
,
Bi" #
City of La Quinta
-0ed . ACS -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 # �Q�
C�
Project Address: C-01 ��
wner's Name: RD .1 l
A. P. Number:
Address: .60
Legal. Description:
City, ST, Zip:
Contractor:
Telephone: - �-lr•�.:;::>:«:»>:;a;s;:;;s:<-;:::>:;;<%»
Address:S I L�
Project Description:
lAb
City, ST, Zip:
!O ,- Le
Telephone:
IL
State Lic. # : L
City Lic.'#..
, r W c) Cc) f
Arch., Engr.,esigner:
Address:.
City, ST, Zip: Q 1 P
Telephone:
>�`:<`:;:'::::>::::r:<.::s:<;;;:::::.:::.;:•::•;;,::
Construction Type: �p Occupancy:
type (circle one): New Add'n Alter Repair Demo
State Lic. #:Project
..::i <: :
...::..
Name of Contact Person:a6 ('A/%_Sq.
Ft.:
# Stories:
# Units:
Telephone #,of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
T'RACMG
PERMIT FEES.
Plan Sets
3
Plan Check submitted
*//4
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Pians picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°" Review, ready for correctionsfissue
Electrical
Subcontactor List
Called Contact Person
Plumb' g
Grant Decd
Plans picked up
S. .I.ir
it,
H.O.A. Approval
Plans resubmitted
Gra i
N ID ro
IN HOUSE:-
'`" Review, ready for correctionsfissue
Devel er Impact Fee
S1GAJ 6,O
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees