05-1874 (RC)R.O. BOX 1504
78-495 CALLE TAMPICO
./,-LA QUINTA, CALIFORNIA 92253.
4.
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number:0,5=00001874
-----------------=------------------------------.—
- - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Owner:
Property Address: 47100 WASHINGTON ST STE 101
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
MCDERMOTT COLIN J
APN: 643-200-023- - -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is.
75200 CHIPPEWA
Application description: REMODEL - COMMERCIAL /1 (7
INDIAN WELLS, CA 92210
Property Zoning: COMMUNITY COMMERCIAL
D
[rte
u
OWNER -BUILDER DECLARATION
Application valuation: 86000 •
_ insurance carrier and policy number are: .
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
"Carrier. STATE FUND ' Policy Number 1814653
AUGUr 0 8.
20U5
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter,'improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
_ person in any manner so as to become subject to the workers'. compensation laws of California,
Contractor:
Applicant: Architect or Enginee :
- and agree that, if I should become subject to the workers' compensation provisions of Section •--
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
HOLCON BUILDER INC
- - - 3700 of theLaborLabor Co�rthwithcomply w' se provisions.
CITY OF LAQUINTA
1840 COMMERCE UNIT A
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
F!ldAWCE DEPT.
te:s-..Applic
NORCO, CA 92860
y
- _the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
(951)272-8995
p�
. Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
Lic. No.: 505547
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 77717153
Date: 7/29/05
------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
-----------------=------------------------------.—
- - WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.
'_ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class: B C10 License 505547 -
for by Section 3700 of the Labor Code, for the performance of the work for which this permit is.
�_ts df�
:ontrac or.
-issued.
I have and will maintain workers' compensation insurance, as required by Section 3700 of the LaborCode,
for the performance of the work for which this permit is issued. My workers' compensation
OWNER -BUILDER DECLARATION
_ insurance carrier and policy number are: .
hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
"Carrier. STATE FUND ' Policy Number 1814653
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
I certify that, in the performance of the work for which this permit is issued, I shall not employ any
construct, alter,'improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
_ person in any manner so as to become subject to the workers'. compensation laws of California,
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
- and agree that, if I should become subject to the workers' compensation provisions of Section •--
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
- - - 3700 of theLaborLabor Co�rthwithcomply w' se provisions.
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).:
te:s-..Applic
(_ 1 I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and
r
- _the
structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
. Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
and who does the work himself or herself through his or her own employees, provided that the
DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
improvements are not intended or offered for sale. If, however, the building or improvement is sold within,
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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.).
1 _ I 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
- 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 incorrect. I agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
of thiity to enter upon the above-mentioned piopef6y f tion purposes.
D�Slgnatuie.(Applicantor-Ag t):-E� -.
dddd
Application Number . . . . . 05=00001874
Permit . . . BUILDING PERMIT
Additional desc _.
_. Permit'Fee576.50 Plan Check Fee
374.73
Issue Date Valuation'
86000
Expiration Date :, 1/25/06-:
Qty Unit Charge Per
Extension
BASE FEE
414.50
36'.00 4.5000 THOU BLDG 50,,001-100,.000
162.00
Permit -ELECT__- ADD/ALT/REM
Additional desc
Permit Fee 128.80 Plan Check Fee :
32.20
Issue Date : Valuation . .
0
- Expiration Date 1/25/06
Qty Unit'Charge Per
Extension..
'BASE FEE
15.00
5690.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL
113.80
Permit MECHANICAL
Additional desc .
Permit Fee 32.50Plan Check Fee
8.13 .
Issue Date Valuation
0
Expiration Date 1/25/06
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 4.5000 EA'' MECH VENT INST/ DUCT ALT
4.50
2.00 6.5000 EA MECH VENT FAN
13.00
Permit PLUMBING
Additional desc .
Permit Fee -72.00 Plan Check Fee
1'8.00
Issue Date. Valuation
0
Expiration Date 1%25/06
Qty Unit Charge Per
Extension
BASE FEE.
15.00
9.00 6.0000 -EA PLB FIXTURE
54.00
1.00 3.0000 EA PLB WATER INST/ALT/REP z
3.00
Special Notes and Comments
Commercial Remodel "Tarbell Realtors" -
. LQPERMIT
Application Number . . . . . 05-00001874
{
--------- --------------------------------------------------------
Special Notes and Coments
°TI, 5,690 sgft, Type'VN Sprinkled,
"B"
Occupancy,.Occupant Load 47
- --------------------------------------------------------------------
'Other'Fees STRONG•MOTION
(SMI) - COM
18.06
Fee summary _ Charged
Paid
Credited
Due
--------------
Permit Fee Total 809.80
------------
.00
----------
.00 •
809.80
Plan Check Total 433.06-•
.00.
.00
433.06
Other Fee Total ,- 18.06
.Ob
.00
18.06
Grand Total 1260.92
.00
.00
1260.92
c
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• LQPERMIT
Permit '
City of La Quinta...
Building 8r Safety Division
P.O. Box1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
.Project Address: j4 -7101b.
A. P. Number: e-, T-�
Legal Description:
Contractor: 4OLC Off} F3 0(4-J>1' ;? JJ C_
Address: 1940
City, ST, Zip: �/.1 t �
Telephone (p-71
O
Project Description:
City, ST, Zip: � C �
D
.............
Tele h n'
State Lic. # : S D S S 41 % City Lic.
Arch., Engr., Designer:
2fl✓ �M�
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Con s truct�
i on Type:Occup c ••
V
Project � ct t}•pe (circle one): New Add'n Alter Repair
Sq. Ft:: # Stories: # Units:
Name of Contact Person: I-
404
Telephone # of Contact Person(90 ( -70R-
-L-1
-7 3 D I.
APPLICANT: DO NOT
# Submittal Req'd Rec'd
TI
3_' Plan Sets
Plan Check submitted
Structural Calcs.
Reviewed, ready for c<
TrussCalcs.
.Called Contact Person
Title 24 talcs.
Plans picked up
Flood plain plan
Plans resubmitted
Grading plan
2"d Review, ready for c
Subcontactor List
Galled, GontactiPerson
Grant Deed
Plans picked up
II.O.A. Approval
Plans resubmitted
INHOUSE:-
1r° Review, ready for cc
Planning Approval
Called Contact Person
Pub. Wks. Appr
School Fees t >.^�A
.. ,
Owner's Name: C M e f
'Address: 2 S" DO C 141 PP 157 ce) p.
City, ST, Zip: �/.1 t �
Telephone (p-71
O
Project Description:
We c -L C
6 S
D
.............
n9 T
2fl✓ �M�
i-
Con s truct�
i on Type:Occup c ••
V
Project � ct t}•pe (circle one): New Add'n Alter Repair
Sq. Ft:: # Stories: # Units:
Demo
Estimated Value of Project:
VNRITE BELOW THIS LINE
.ACKING
S/WoI
�(,� 00,0 ,
PERMIT FEES
tem
Amount
rrections ����
Plan Check Deposit
Mile—
Plan Check Balance
9
Construction
Mechanical
trr�issu �'/
Electrical
Plumbing
S.M.I.
Grading "
rrections/issue
Developer Impact Fee
A.I.P.P.
Olin
tt� W-P—MA
--.-tea --.--�
--
Total Permit Fees
-----------------
5// 7 N05A.a %aAAA e/v 4u.¢., 7
CD
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1 1
RIVERSIDE COUNTY
FIRE DEPARTMENT
HIghW ay ., Indio, CA 92201. Fax (760) 863-
.
June 2, 2005
Craig E. Anthony
Fire Chief
Holcom Builders, Inc:
Proudly serving the
1840 Commerce, Ste. A
unincorporated
Corona, CA 92860
areas of Riverside
County and the
Cities of:
R0: Non -Structural Building TA Plan Review
LAQ-05-TI-051 / Tarbell Realtors
Banning "'
4.
47-100 Washington St.
Beaumont
Fire Department personnel have completed a review of the plans you'submitted for the above
4'
referenced project. Please be advised the following conditions or corrections must be completed and'
Cahmesa
•;• .
approved by the Riverside County Fire Department before a building permit can be issued.
Canyon Lake
;.
1) Sht. A -A — Provide appro riate occupant load analysis specific for the 'mixed =use areas. Individual
Coachella
room occupant loads shall be calculated on the occupant load factor most closely resembling the
.;.
actual use. (Account for Entrance (Lobby), Break Room and Training areas.)
Desert Hot Springs
❖
2) Sht. A-1 — Revise floor plan to reflect the minimum required egress access doors according to ihg
Indian wells
❖
revised cumulative occupant load.
Indio
3) Sht E-3 — Correlate exit door location references, including signage, with Sht. A-1.
Lake Elsinore
4.
All questions regarding the meaning of these conditions should be referred to the Fire Department
La Quinta
❖
Planning & Engineering staff at (760) 863-8886.
Moreno Valley '
,
•�•
Sincerely,
Palm Desert
•�•
FRANK KAWASAKI
Penis
Chief Fire Department Planner
Rancho Mirage
San Jacinto
a/
.;.
B y
Temecula
Walter Brandes
Fire Safety Specialist
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Teff Stone,
District 3
Roy Wilson,
District 4
Marion Ashley,
Districts
HAPEMP DataLLa amta%PROJECMTIUAQ- Th-MI(a).doe.
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 21d FL, Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
t
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,
Certificaeccupantof
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9 &Safety Dep_ artmen_ t_.
OF 'f1
SBulding ,
This Certificate is issued pursuant to the requirements of Section 109 of'the .California", Building
Code, certifying_ that,,-- at the time of ; issuance, . thin; structure, was , "n. compliance with` : the
provisions of the:. Building,: Code and ' the .various ordina`nces� of the City. regulating, building .
construction an d%r use. ��. y '�
A. �r
J
r` .• .` Ory � � cV � _- � ,.� • .4 � '``• ,1,,'+`.:-\'
�" ! �I. <, � -, -
- ] ,BUILDING'ADDRESS: 47- 00'Washin4ton Street Suite 101
' classification Corninercial ",Tarbell:Realtors"TI . f �.,♦ �' Building Permit No.: 05-1874
..Use _
fi Occupancy Group:'B Type of Construction: VN Sprinkled wLand Use`Zorie,CR"
_. — —
yJ
of -Building: Colin. McDermott Address,75=200 Chippewa
Owner 6f
��
City, ST, ZIPIndian Wells,•Ca 92210' i
By: Daniel P..Cravirfocd Jr.` .
,1 DateA/18/05
` •Building Official
x}. POST INA CONSPICUOUS PLACE. 4 o r
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