04-6168 (RC)QUWC44j
;::::e,
BUILDING & SAFETY DEPARTMENT
P
c Hw �3 P:O. 'Box 1504. (760),777-.7012
QFe U �78„49S GALE TAMPICO � FAX 760 777-7011
O SLA. QUINTA CALIFORNIA 92253 INSPECTION 'REQUESTS. (760).777.-71-53;
BUILDING PERMIT
Application Number c04=00006168:_ Date. 10%06/04
Property Address `47050 WASHINGTON ST..,
APN: 643-200-019- -
Application description'.'.' REMODEL - COMMERCIAL
Property Zoning COMMUNITY'.COMMERCIAL
App l:ication,.valuation 25000
Owner
Contractor
LA QU.INTA DEVELOPERS
AFFILIATED CONSTRUCTION
CO INC
..0/O.WES.OLIPHANT'
77900N AVE OF THE STATE
77.900 AVENUE .OF THE .STARS.
PALM. DESERT :.' " CA
: 9221:1 :•':
PP,LM`DESERT.
CP; `92211 (760) 345=2626
WCC.:. STATE `. FUND .,.
WC.: . :.' 17691.0720.042..
.. 04•/01/05 .
CSLB: 186.863
'' 11/30/05.
CCC:. B
------ Structure Information
COMMERCIAL REMODEL
-----
Construction Type
TYPE V - NON RATED
Occupancy Type
..BUSINESS <50
Other struct info
CODE EDITION 2001
l
FIRE SPRINKLERS.... YES.
..':
OCCUPANT LOAD '' :.. ' , :13'.
0 0 .
SECOND FLOOR SQ FTG' 1265.00.
Permit. ,:
BUILDING:'PERMIT ..
Additional de,sc:
Permit Fee.
252.00 Plan -Check Fee
163.80
Issue.Date . .
Valuation ..
25000.
Qty` Unit Charge
- Per Per
Extension
..
BASE FEE..
45:00
.23.00 9.0000
THOU.. BLDG 2,.001-25,000
207.00
Permit
ELECT - ADD/ALT/REM
Additional•desc
Permit. Fee
40.30 Plan Check 'Fee
10:08
Issue Date
Valuation
0
Qty. Unit Charge
Per
Extension
BASE FEE
15.00.
1265.00 :020.0
ELEC GARAGE OR NON-RESIDENTIAL
25.30
P.O. BOX 1504 •
VOICE -(7-60)777-791-2
78-495 CALLe TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 922.53 INSPECTIONS (76.0)' 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: — Date: '0
Applicant: Architect or Engineer:
Applicant's Mailing Address: Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
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 Professionals
'Code, and my Lice n is in full force and effect
License Class_ License No.17
Date Contractor
ER43UILDER DECLARATION
I hereby affirmunder penalty of perjury that I a xerript from the Contractors`, State License Law for the following reason (Sea 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 Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) outhat 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 fere hundred d68ars ($500).):
U l; as ov!ner 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 (Seca 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 or through his or her own employees, provided that the improvements are not Intended or offered for sale. If. however; the bulding 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
U 1, as owner of the property, am exclusively contracting with licensed contractors to constrict the imn ogle.).
the purpose C
State. License Law does not apply to an ownof property who builds thereon,arh
ds or project (Sea 7044, Businnessess and Professions Code: The Contractors' '
d who contractsfor the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.). er
U I am exempt under Sec. . B.B,P.C. for this reason
Date Owner
WORKERS' 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 tabor Code, for the performance of the work for which this permit is
ed. workae con np ensation Insurance Zmer nil pd nr mbeJ o@
Carrier i/1 >fU J7 Policy Number / �� ! t2 ��Z�'' .
_ I certifyVi5t, In tie performance of the work for which. pewit Is Issued. IIsshall not employ any person in any marshal so as to become subject to the workers' =
cornpensation laws of cardomlai and agree that, If I should become subject fA the workers' compensation proWsions of Section 3700 of the Labor Code, I shad
forthwith comply with time provisions.
WARNING: FAILURE TO SECURE WORKERS' CENSATION COVERAGE IS UNLAWFUL", AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND LIARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for thhe.peffommance of the wok for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lenders Address
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 Palated 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 Ifwork 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 comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county to en a '�"'y "" ed property for inspection purposes.
Date w Signature (Applicant or Agent):
y
,
i
1
Page
2
Application Number
04-00006168
�, Date
10/06/04
Permit
MECHANICAL
Additional desc
Permit Fee
19.50
Plan Check
Fee
4.88,
Issue Date . . . .
Valuation
0
Qty, Unit Charge
Per
Extension
-
BASE'FEE
15.00
1.00 4.5000
EA MECH VENT.INST/
DUCT ALT
4.50
---------------------------------------------
Permit.
PLUMBING
-------------------------------
Additional,,desc
Permit Fee
48.00
Plan Check
Fee
12.00
Issue Date
Valuation,
0
Qty Unit Charge'.
Per,
Extension
BASE FEE
15.00
5.00 6,.0000
EA PLB FIXTURE
30.00
1.00 3.0000
EA,, PLB WATER
INST/ALT/REP
.
3.00
Special Notes and'Comments
Commercial Remodel "Office"
TI (1265.
sgft), "B" Occupancy,.Type
VN Sprinkled,
Occupant Load 13.
---------- ----
'
-----------------
--------
,Oth
,Other Fees . . . .
-----------------
.• STRONG
MOTION (SMI)
- ------
; COM
i
------
7-7-
5.25
Fee summary Charged
-----------------
Paid
Credited
Due
--=-----=-
Permit Fee' Total
-------=--
359.80
--------!-
.00
----------
.90
359.80
Plan Check Total
190.,76
.00
.00
190.76
Other Fee Total
5.25
,00
.00
5.25
Grand Total
555.81
00
00
555.81
09/03/2004 11:11 7607777011 LA QUINTA PAGE 01/01
# •
p2� City of 'La Quetta
Iv, Building a Safety Division
Pernik # D P.O. Box 1504, 78.495. GUe Tampico
�p D La Quinta, G 92253 • (760) 777-7012
D�' 1 Building Permit Application and Tracking Sheet
Pro}eM Aad:ew.
S - Owner's Nana
A P. Number: ✓/ G 4W 7., Add,.Z:
1:ega1 Desciiptioa: City. ST. Zip:
X COtttRetQr 1`Telcphoae:
J� Address: V jell DeScxiptlon '' �:4
X aly, ST, rip: , LP, I/
. JC
Telephone.� �' : '. -'.',. ••;: ~ `�7>�-G�%L(-•�-A't_
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Stere Lia r : City Lie l!:
Arch- Engr, Dc dpj,.
'Add=,.
city. ST. Zip.
Tckphom
Construction Typo
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$tate Lia 11:
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Jtype itdrde one):
New Add'n Alter Repair Denw
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Name of Conteet Person:
xSq. FL:
r
Stories-, d unit:
X
Telephone d of Contact Person:
345
wed Value of
APPLICANT; DO NOT WRITE BELOW THIS UNE
a Submittal d
Rec'd TRACKING
PERMIT FEES
Ptao Sets
Plea Check aabmiltcd V7
Item AmaRat
..Straetural talcs:` .:..•:: •.. _.:
•.:.:._...::::. -
Ite:ie* e�►taay fol eorreetioas �'
Plao Check Deposit -
Tress Cala
Called Coatatt Pelson �J
Plan Check Balaste
Energy Cika. L
Pisas kicked up
Constrnetios
F{ovd plain pis%
Titus reaubtaittcd
-
Mechanical
Grading pian
2" Review, ready for
eor— ae
letirical
Subeontaetor Lest
Called Coaaa Peaoa t'}
Plumbior
Grant peed
Piaas picked up
S.11f.t.
H.O.A. Approval
Plans resubmitted
Grading
IN HOtTSE -
"' lierien. rtady for eortectioos/issue
Developer Impact l:'ee
P12RDIRC Approval
Called Contact leme
AJ.l.lP.
Feb. Wks Appr
pate of permit issue 41110
School Ft"
""'—
--•••
Total Permit Fen
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of.
Banning
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
La Quinta
Moreno valley
Palm Desert
Perris
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3 l
Roy Wilson,
District 4
• t
RIVERSIDE COUNTY
FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 • (909) 940-6900 • Fax (909) 940-6910
a
December 22, 2004
To: La Quinta Building Department
Re: Final fire Clearance
J
The Riverside County Fire Department is granting a fire life safety clearance for
# LAQ-04-TI-118 L La Quinta Professional 7 050 Washington` Steet Sui� _ to #4202
t
If you have any questions contact me at 760-345-6954
j.
Respectfully,
c i
Neap Stephenson
Fire Systems Inspector
s
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i
147 . • - .1, ter! `\
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. Cert�fca to of 06�.0 angy.r . {
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Buldiri =&-Safet De actinent-
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This Certificate 4s issued pursuant oto the' requir'ements'of Section,.109"'of. the California Building
Code, certifying _ that' at, the •time° of � issuance; "this, structure , was in .-cornpliance,..with ,the
provisions of the -Building Code and they various: ordinances of the -City regulating building
construction and/or use
BUILDING ADDRESS:, 47-050 Washington,St.'Suite 4202,',-._
.
}Y•, ' '; ♦ } ti f ,� I' • {i " i.• 5 Y /�vya`• f } :'`.. t y.
Use classification: Commercial Office `� rev',-' �,� `,:r L Building. Permit No. 04-6168
y
Occupancy Group' B, Type of Construction: VN Urinkled "`1tand_Use ZOne:'CIR
�Owner of Building: La=Quinta-Developers } w . ? Address:''77-900 Avenue of the Stars
,
City; ST ZIP:"Palm Desert, CA 92211
By: Daniel P. Crawford Jr."
77:Date:.1/18/05`
' 'Building Official = -
' 1 ''• POST IN A CONSPICUOUS PLACE •' ' r
147 . • - .1, ter! `\