0207-015 (CSCS)q LICENSED CONTRACTOR DECLARATION
IAhereb affirm under enalt of perjury that I am licensed under provisions of
,. Y P Y• P l Y •
„H Chapter 9 (commencing with Section 7000) of Division 3'of the Business and
° ? CV LU Professionals Code, and my License is in full force and effect. ,
ch • License # ; ' Lic. Class Exp. Date
r- CYLU 198069 i AB X9/30/03
` c Z r�_ " —Date j' .Signature of Contractor.
J ca OWNER -BUILDER DECLARATION
Hd 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
U)License Law for the following reason:
Z ( ) I, as owner of the property, or my employees with as their sole
c compensation, will do the work, and the structure is not - • t nde or offered for
;sale (Sec.'7044, Business & Professionals Code).
( ) , I, as owner of the property, am exclusively c r t with licensed
contractors to construct the project (Sec. 7044,- B Professionals.
Code). w
(•), I am exempt under Section B&P. for ' reason --�
Date • * Signature of • Owne
'WORKER'S COM SAT D LARATION .
1 hereby affirm under penalty of per'ury on the. following declarations: ,
() I have and will maintain a certifi to of consent to self -insure for workers'
compensation, as provided for by J n 3700 ,of the r Code, for the
performance of the work for whichissued.
( ) I have and will maintain wor s' c• pensation i ace, as uired by
f the
Section 3700 of the Labor Code, erformance or hich this
,permit is issued. My workers', tion insurance ca & icy, no. are:
CarrierAMERICAN GU Polic 307-03 µ -
(This section need not b pleted if the perm) Val for $100.00 or less). .
O I certify that in ' erfo �e of the work for, this permit is issued,
I shall not employ in niy manner so as t ecome subject to the
workers' compens t' of California, and-agree.t t if I should become
subject to theW pensation pro s of Sect 3700 of the Labor
Code, I shall f W t ply With those &M S.
Date: plicant
410
Warning: cure Work ' nsation coverage is unlawful and
shall subje a oyer to criminal s and civil fines up to $100,000, in
i; addition t of compensate ges as provided for in Section 3706
Of the La C r an s S. '
IM RTA Application i r de to the Director of Building and Safety
for rm' ubject to-th on (tions and restrictions set forth -on his
applic I n.
I. Eac • son upon o h this application is made & each person at
whose request and for benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
&,hold harmless the City of La Quinta, its officers; agents and employees.
—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 State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
°the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
,..
r BUILDING PERMIT PERMIT# '
.0207-015 '
DATE VALUATION LOT TRACT
$29120,020.00 = •Par7 - 27892
JOB SITE' ]APN,_'.-
ADDRESS.47-200 WASHINGTON STREET ti
643-200-007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
TENET HEALTH SYSTEMS : • '
RUDOLPH'& SL.ETTlEN, INC. ,
13737 NOEL s
16851 HALE AVE. r
DALLAS .�.• • Tat •73380
.
•IRVINE CA 92006
- +
(949,)252.1919 - CBL#' ,4777
'
USE OF PERMIT s
CO1AhCMCL L
E `,
25,486 SQ.FT.,OUTPATIENT DIAGNOSTIC 1 SURGERY FACILITY. I . -
1.2 / B OCC,, TYPE II I -HOUR CONSTR. , `' f
PORCH/PATIO ' 814.00 SF
SPRINKLER * 25,486.00,SF
,
A/C -- COMMERCIAL 25,486.00'SF.
'
i CONTRACT AMOUNT 1,901,255.60 LS
{
CARPORT Y`. 5,670.00 SF
EMMATEDaCOST OF CONSTRUCTION
2,120,020.00
PERMIT FEE SUAD4ARY-
' CONSTRUCTION FEE _ 101-000.418-000. $5,851,50`
PLAN CHECK FEE -101-000-439-318 , $4,759.92
`
FEE DEPOSIT, '101-006-439-318 43,500,00'
MECHANICAL FEE 101-0007-421-000 4 - $588.50
-ELECTRICAL FEE . 101-000-420.000 $900.12_
"
PLUMBING FEE 101-000-419-000 .$815.75
STRONG MOTION FEE - COMM '100-000-241 -000 $452.71
'
ORADINO FEE 101-000-423-000 '' $15.00
d -
DEVELOPER IMPACT FEE :' $57,496.42
_
ART IN PUBLIC PLACES - COMP 270-000-445-000 ' . $10,778.71
ELECTRICAL FEE 101-000-420.000 - $44.23
-
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$81",702.8$
' �L_ ESS PRE -PAID FEES
,, -$3;500.00
L
.
»• - TOTAL PMMUT-FEES DUE NOW
7 $78,202.88
RECEIPT'
DATE
BY
DATE FINALED
INSPECTOR
10/8/03
477200 Washington Street — Tenet Health Systems
RTKL Associates, Inc., Dallas, TX (Eric Dinges 214-871-8877)
o Application date: 7/2/02
o Application expiration date: '12/30/02
U 'Extension request letter date: 11/2/02
U Extended application expirationdate: 6/30/03 '
6 -Application has expired in plan check.,
U •Plan check document discarded on 10/8/03
U Plan check deposit paid: $ 3,500.00
o Actual plan check fee: $ 4,759.92 " {
Plan check balance due:•$ 1,259.92
o Balance due'must be paid before Building Department action, can begin on
any new application
!lo $ 03
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D— —— — — — — —— —'i4 48TH AVENUECy-
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02
lt, • NlA►� TO.ER►a v �a465
March, 11:, 2003
Dear Eric:
Regarding your recent inquiry about the possible construction delay or
cancellation for Tenet Health Systems' diagnostic/surgery center here in La
Quinta, there are several options available.
Current.Application.Timeline .
Original. application date: 7/2/02
Application expiration date: 12/30/02
Extension request letter date: 11/2/02
Extended application expiration date: 6/30/03
Option #1: Let the application expire. If no action is taken, the application will
expire on 6/30/03. The $3,500 plan check deposit paid at the time of application
will be forfeited and applied against the actual plan check fee of approximately
$4,800. If the project is resurrected after that date, a new application will be
required, as well as new plans drawn to the requirements of the currently
adopted Building Code,. The application will require a -new deposit, covering the
plan check balance due from the expired application and the anticipated cost of
the new plan check.
Option #2: Pull building permit and cancel before permit expiration. By .
pulling the building permit prior to application expiration on 6/30/03, the
opportunity to construct this project under the currently, approved plans (and the
1998 California Building Code) is extended an additional 180 days. -if the building
permit is issued on'6/30/03 and construction is not begun; it will expire on
12/29/03. If a written application for refund is received. by the Building
Department on or before 12/29/03,. a portion of the fees paid would be
refundable. Of the balance due of ±.$78,000, approximately $74,000.would be
refundable. If this option is selected and construction is not begun nor refund
requested, the permit will expire as above on 12/29/03 and ,approximately
$68,000 would be refundable.
Option #3: Pull building permit and request extension prior. to expiration. If
the building permit.is issued on 6/30/03; it will expire.on 12/29/03 unless
extended. If a written application for extension is received by the,Building
Departmenton or before 12/29/03; the permit may be extended for not;more than
an additional 180 days. Then, if construction is not begun, the permit will
expire on 5/24/04. In this case, approximately $68,000 would be refundable.
Reference Code Sections
CBC §107.4 — "Expiration of Pla`n,Review. Applications for which no permit is
issued within 180 days following the date of application shall,expire by
limitation..' The building.official may extend the time for action by the applicant
for a period not exceeding 180 days on request by the applicant.:. No application
shall be extended more than once."
.F CBC §107.6 — "Fee Refunds....The building official may authorize refunding of
w any fee paid hereunder. which was erroneously paid or collected.
"The building official may authorize refunding of not more, than 80 percent
of the permit fee paid when no work has been done under a permit issued in
accordance with this code...
"The building official shall not authorize refunding of any fee paid except
on written application filed by the original permittee not later than 180 days after
the date of fee payment."
CBC §10634.4 — "[Permit] Expiration. Every permit issued by the building
official under the provisions of this code shall expire by limitation and become
null. and void if the building or work authorized by such permit is not commenced
within 180 days from the date of such permit...
"Any permittee holding an unexpired permit may,apply for an extension of
the time within which work may commence under that permit when'the permittee
is unable to commence work within the time required by this section for good and
satisfactory. reasons. The building official may extend the time for action by the
permittee for a period not exceeding 180 days on written request by the
permittee showing that circumstances beyond the control of the permittee have
prevented action from being taken. No'permit shall be extended more" than once.
Sincerely,
Greg Butler, .Building & Safety Manager
City of La Quinta .
78-495 Calle Tampico
La Quinta, CA 92253
(760) 777-7015 (voice)
(760) 777-7011- (fax)
gbutler@la-quinta.org