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08-0303 (CSCS)P.O. BOX 1504 78-495 CALLE TAMPICO LA-QUINTA, CALIFORNIA 92253 c&ty/ 4 4 Q" BUILDING & SAFETY DEPARTMENT BUILDING PERMIT ----------------- 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 oft Business and Professionals Code, and my License is.in full force and effect. License Class: ��B®® Li�rennse /No.: 808029 ✓Dates', -`"0 1rContractor. �.� 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 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 contractor's) licensed pursuant to the Contractors' State License Law.). ( 1 1 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: LQPERn1IT Owner: HIGHLAND LA QUINTA 80 S LAKE AVE STE PASADENA, CA 91101 II LLC 660 Contractor: PATTERSON BUILDERS 13057 VICTORY BLVD NORTH HOLLYWOOD, CA 9160 (818)762-5795 Lic. No.: 808029 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/09/08 ------------------ 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. 1 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 1763924-2008 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. mate: 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 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 county to enter upon the above-mentioned for inspection rposes. at6ila�-ti`�i�Signature (Applicant or Agent): "" �/� Application; Number: 08-00000303 Property Address: 78130 CALLE TAMPICO APN: 770-020-012- - - Application description: NEW COMML - STORES & CUSTOMER SERVICE Property Zoning: VILLAGE COMMERCIAL Application Valuation: 616657 Applicant: Architect or Engineer: 01-6#44d F AVSX,. ----------------- 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 oft Business and Professionals Code, and my License is.in full force and effect. License Class: ��B®® Li�rennse /No.: 808029 ✓Dates', -`"0 1rContractor. �.� 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 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 contractor's) licensed pursuant to the Contractors' State License Law.). ( 1 1 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: LQPERn1IT Owner: HIGHLAND LA QUINTA 80 S LAKE AVE STE PASADENA, CA 91101 II LLC 660 Contractor: PATTERSON BUILDERS 13057 VICTORY BLVD NORTH HOLLYWOOD, CA 9160 (818)762-5795 Lic. No.: 808029 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 6/09/08 ------------------ 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. 1 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 1763924-2008 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. mate: 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 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 county to enter upon the above-mentioned for inspection rposes. at6ila�-ti`�i�Signature (Applicant or Agent): "" �/� Application Number . . . . . 08-00000303. ------ Structure Information 13969 MARKET SHELL BLDG ----- Other-struct info . . CODE EDITION 2007 FIRE SPRINKLERS, YES MIXED-USE OCCUPANCY SHELL (M OCC) OCCUPANT LOAD .00 PATIO SQ FTG 572.00 1ST FLOOR SQUARE FOOTAGE 13969.00 2ND FLOOR SQUARE FOOTAGE .00 ----------------------------------------------------------------------------- Permit. . BUILDING PERMIT Additional desc 13969 MARKET.SHELL BLDG Permit Fee 2390.50 Plan Check Fee 1553.83 Issue Date Valuation 616657 Expiration Date 12/06/08 Qty Unit Charge Per. Extension BASE FEE 2039.50 117.00• 3.0000 THOU BLDG 500,001_-1,000,000 351.00 Permit . . ELEC-NEW.COMMERCIAL Additional desc . Permit Fee . . . 294.38 Plan Check Fee 73.60 Issue Date . . Valuation 0 Expiration -Date 12/06/08 Qty Unit Charge Per Extension BASE FEE 15.00 13969.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 279.38 Permit MECHANICAL Additional desc,. 1 -SUMP PUMP Permit Fee 21.50. 'Plan Check Fee 5.38 . Issue Date Valuation . . . . 0 Expiration Date 12/06/08 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 6.5000 EA MECH OTHER MECH EQUIPMENT 6.50 ------------------------------------------------------------------------------ Permit . . . . . PLUMBING Additional desc . Permit Fee . . . . 94.50 Plan Check Fee 23.63 Issue Date' Valuation . . . . 0 LQPER-kIIT - ' ;r-' .4 Application Number . . . . . 08-00000303 Permit . . . . . PLUMBING Expiration Date 12/06/08 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 5.00 6.0000 EA PLB ROOF DRAIN 30.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 1.00 9.0000 EA PLB LAWN SPRINKLER SYSTEM 9.00 1.00 7.5000 EA PLB OTHER BACKFLOW <=2 INCH 7.50 . 1.00 15.0000 EA PLB GAS METER ---------------------------------------------------=------------------------ 15.00 Permit . . . . . GRADING PERMIT Additional desc . Permit Fee 15.00 Plan Check Fee .00 Issue Date Valuation . . . 0 Expiration Date'. 12/06/08 Qty Unit Charge Per Extension BASE FEE 15.00 ---------------------------------------------------------------------------- Special Notes and Comments 13,969 SF "SHELL" BUILDING. [FRESH & EASY MARKET "M" OCC. PROPOSED) TYPE V -B CONSTRUCTION.FIRE SPRINKLER CREDIT FOR ALLOWABLE AREA INCREASE PER CBC 506.1 2007 CODES **PERMIT DOES NOT INCLUDE TEMP POWER, BLOCK WALLS, WATER FEATURE, TRASH ENCLOSURES AND SITE LIGHTING** ---------------------------------------------------------------------------- Other Fees . . . . . . ... ACCESSIBILITY PLAN REVIEW 155.38 ART IN PUBLIC PLACES -COM 3063.28 DIF CIVIC CENTER - COMM 4498.01 ENERGY REVIEW FEE 155.38 DIF FIRE PROTECTION -COMM 628.60 STRONG MOTION (SMI) - COM 129.49 DIF STREET•MAINT FAC -COMM 1480.71 DIF TRANSPORTATION - COMM 42451.79 Fee summary, Charged Paid Credited ---------- Due ----------------------------------------------- Permit Fee Total 2815.88 ..00 .00 28.15.88 Plan Check Total 1656.44 1200.00 .00 456.44 Other Fee Total 52562.64 .00 .00 .52562.64 Grand Total 57034.96 1200..00 .00 55834.96 LQPERMIT vg- 00-3 tu',,K,rcv P.O. BOX 1504 APPLICATION ONLY Building/ /1 78-495 CALLE TAMPICO Address 78—/-30 -3V Calle Tampico LA OUINTA, CALIFORNIA 92253 Owner fully sprinklered M—for Retail Highland Development Company BUILDING: TYPE CONST. V—N OCC. GRP. B—for Eating Place Mailing Address 80 South Lake Ave., Suite 660 A.P Number 770-020-012 See attached City Zip Tel. Pasadena 91101 (626)696-2009 Legal Description Estimated Valuation $750,000.00 PERMIT Project Description proposed neighborhood center Contractor Patterson Builders, Inc. includes market plus two retail pad buildings Address Const. 13057 Victory Blvd. Mech. City North 19n] Lywmd Zip 91finis Tel. (310)940-0953 Plumbing Sq. Ft. No. No. Dw. Size 13,969 Stories 1 Units State Lic. & Classif. 808029 B-1 City Lic. # 104234 Arch., Engr., I Designer Olshan & Associates, Inc. Address Tel. 811 7th St., #B (310)394-3132 CityZip State Santa Monica 90403 Lic.# C-6004 LICENSED CONTRACTOR'S DECLARATION I hereby affirm 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. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that he 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, 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 Profes- sions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or im- provement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law) O 1 am exempt under Sec. B. & P.C. for this reason WORKER'S COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less). 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 Workers' Compensation Laws of California. Date Owner NOTICE TO APPLICANT If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. 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 the above-mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip WHITE = BUILDING DEPARTMENT Newk Add ❑ Alter ❑ Repair ❑ Demolition ❑ REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE_ Issued by: Validated by:_ Validation: YELLOW = APPLICANT INSPECTOR Date Permit PINK = FINANCE Estimated Valuation $750,000.00 PERMIT ��Q3 AMOUNT Plan Chk. Dep. % n 00 t Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure OF FD TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE_ Issued by: Validated by:_ Validation: YELLOW = APPLICANT INSPECTOR Date Permit PINK = FINANCE CERTIFICATE OF COMPLIANCE Desert Sands Unified School District 47950 Dune- Palms Road Date 6/13/08 La Quinta, CA 92253 No. 30081 (760) 77.1-8515 � 21ED Q BERMUDA DUNES r En RANCHO MIRAGE �. INDIAN WELLS d� PALM DESERT y LA QUINTA - INDIO L? � m Owner Highland Development Co. APN # 770-020-012 Address 78-130Calle Tampico Jurisdiction La Quinta City La Quinta Zip 92253 Permit # Tract # No. of Units Type Commercial Lot # No. Street S.F. Lot # No. Street S.F. Unit 1 78130 Calle Tampico 13,969 Unit 6 Unit 2 Unit 7. Unit 3 Unit 8 Unit 4 Unit 9 Uriit 5 Unit 10 Comments Official Check No. 188637553 in the total sum of $15;149.98 paid for Certificate 30080 fees'$8,584.55 and Certificate 30081 fees $6,565.43 At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions under 5 00 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking, eating or sanitation) or replacement mobile ho mes. It has been determined that the above-named owner is exempt from paying school fees at this time due to the following reason: EXEMPTION NOT APPLICABLE ,This certifies that school facility fees imposed pursuant to Education Code Section 17620 and Government Code 65995 Et Seq. in the amount of. $0.47 X 13,969 .S.F.' or $6,565.43 have been paid for the- property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued. Fees Paid By OC-Comeria-Bank, "Reggie Kinlaw Check No. 188637553 Name on the check Telephone 310-800=4918 ' Funding Commercial, By Dr. Sharon P. McGehee Superintendent Fee collected leLpte y Patricia Ba�buzza Payment Recd $0.00 $6,565.43 ~ �over1Ugie Signature NOTICE: Pursuant to Government Code Section 020(d)(1), this will serve to notify you that the 90 -day approval period in which you may protest the fees o r other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on which those amounts are paid to the District(s) or to another public entity authorized to collect them on the District('s) behalf, whichever is earlier. NOTICE: This Document NOT VALID without embossed seal - Embossed Original - Building Department Applicant. Copy - Applicant/Receipt Copy - Accounting r # o I . . P ACHELLA VALLEY -WATER DISTRICT ASSESSOR'S PARCEL -NUMBER 995 Avenue 52 Coschdit.CaMonds 92236 .(760) 3984651 APPLICATION FOR WASTEWATER INTERCEPTOR/SEPARATOR APPROVAL APPLICANT: Submit this:fOnn with a copy of a SCALED plot.plan (1' -11Y to I' - WSCALE) drawn to District specifications. A nonrtfW"lc filing fee is required when the application is submitted. Check must be made payable to the Coachella Valley Water District. Approval of this application shall remain valld for a period not to exceed one (1) your from date of payment Plan Chack No. Aa�iraaetor,Con Person Amada City State tip Televhodq^ �in) ��5 % L Cl'r�i Ski /�, i�-i:) �� . 41/7/x/ �,K S/ /e5 S off/' d"�1e�/.J� U/t d C� -U �-./;Z2 Job.pliopgtty Address /9 up Legal Description _ ]DRA CI -qv A l - NOTE: PLANS WILL NOT BE ACCEPTED UNLESS THIS APPLICATION IS COMPLETE AND TIM PLAN CHECK. FEE IS PAID. GENERAL. CONSTRUCTION: Type of Coustrmetion: 7.10 New Food Facility; -Remodel of Existing Food Establishment Houn of Operation. Seating Capedty: .intenw Extetml External Seating with Miners or ttesters Bar with Food Service Bu Nonfood Service Water Soflesta Serdea: Mul6savicc (reusable) SingirService (dispowble) _Y_ OWNER/REPRESENTATIVE DECLARATI)N: I certify that I have nod the intim application and state that all inform lon is Comm I understand that theamount of Ex" paid is beaod. on my dalmatian of information on this form and that incorrect information Is grounds for denial of the•aubmittod plain. 1 also understand that plans will be discarded it not picked up within sixty (60) days of approval or denial and that no inspection of my establishment will be conducted, or approval granted to operate, until ail peva informu ucsted has been received and plans have been approved and retuned. Sips FOR -DISTRICT USE ONLY No, of Syswoa Type of Systems) No. Dwelling Units ❑ Sand/Oil Grease Interceptor Waived Fixture Units' . ❑ Grease Interceptor ❑ New ❑ Existing 0Lint Trap ❑ Replacennew ❑ Addition [j Clarifier D Conuat to.Scwer • Gal. Cheek No. 546F6.2- Date 6Fg2Date S . //. .A initial CVWD-92 1