BCOM2014-100278495 CALLE TAMPICO '
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning: . .
Application Valuation:
Applicant:
BCOM2014-1002 "
47900 WASHINGTON ST ST
643200037
$50,000.00
AUG 2 6 2014
CITY OF LA QUINTA
COMMUNITY DEVELOPMENT DEPARTMENT
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 (commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: License No.: 783299
�, � 1 r—
(Date: Contractor. �E I N
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 fora
permit subjects the applicant to a civil penalty of not more than five hundred dollars f
($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 APPLICANT ACKNOWLEDGEMENT
are not intended or offered for sale. If, however, the building or improvement is sold IMPORTANT: Application is hereby made to the Building Official for a permit subject to
within one year of completion, the owner -builder will have the burden of proving that the conditions and restrictions set forth on this application.
he or she did not build or improve for the purpose of sale.). 1.; Each person upon whose behalf this application is made, each person at whose
(� 1, as owner of the property, am exclusively contracting with licensed contractors request and for whose benefit work is performed under or pursuant to any permit,
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'. issued as a result of this application , the owner, and the applicant, each agrees to, and
State License Law does not apply to an owner of property who builds or improves shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to employees for any act or omission related to the work being performed under or
the Contractors' State License Law.). following issuance of this permit.
( ) I am exempt under Sec. . B.&P.C. for this reason 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.
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/26/2014
Owner:
REALTY TRUST GROUP INC
300 WILMOT RD
DEERFIELD, IL 92253
Contractor:
PLEINC
2279 EAGLE GLEN PARKWAY
SUITE 112-210
CORONA, CA 92883
(951)272-8711
Llc. No.: 783299
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.
I 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: 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.
ate: plicant: 1
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.
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 Add
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:
/�� �,
$ Z' b (� ature (Applicant or Agent):
i
FINANCIAL I •• •
".DESCRIPTION s s ?'N ACCOUNT? .QTY,`; `AMOUNT= +; PAID_`' PAID DATE
BSAS SB1473 FEE 101-0000-20306 0 $2.00 $0.00
*.RECPAID BYi EIPT # , YCHECK # ;�CLTD BYJ
<
i Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $2.00 $0.00
a.
: DESCRIPTION
ACCOUNT;
IyQTYX
ayr $ AMOUNT'°.f.a
' „PAID
-PAID DATE'
DEVICES, ADDITIONAL
101-0000-42403
0
$9.52
$0.00
METHOD v k�
RECEIPT #tia s
CHECK #
CLTD BY.
'DESCRIPTION
,s.
AMOUNT_ -
PAID r i
PAID'DATE-
DEVICES, ADDITIONAL PC
101-0000-42600
0
$2.40
$0.00
. '! PAID BYE r fit','
METHODS' _
RECEIPT# a
,x:y CHECK# ; `'
1,CLTD BY s
¢ `f DESCRIPTION ,
I4 -ACCOUNT, �'
;,QTY€
t -'AMOUNT >'
�t PAID,
PAID:DATE
DEVICES, FIRST 20
101-0000-42403
0
$23.83
$0.00
PAID BY
METHODr
RECEIPT ,#-` k ° k
CHECK # k'
t: CLTD BYE;'
DESCRIPTION'
'.. .
ACCOUNT?*
, AMOUNT,'
PAID
PAID DATE
DEVICES, FIRST 20 PC
101-0000-42600
U
$23.83
$0.00
PAID'BYefg a °<1J� r��
,'. METHOD :r"�s
.RECEIPT#: r
'CHECK#
. CLTD BY.
Total Paid forELECTRICAL: $59.58 $0.00
S` ry DESCRIPTION �.
`R ?�A000UNTgq
*QTY,
I{ AMOUNTS : '
t' ' ; PAID
s PAID DATE
APPLIANCE REPAIR/ALTERATION
-101-0000-42402
0
$11.92
$0.00
PAID{rt< .a T
'¢ " sMETHOD '`
4 i .'oRECEIPT#�x'j�;` i
CHECK#4-CLTD.
BY,!
'DESCRIPTION `' _ ,
ACCOUNT
QTY
k AMOUNT
t PAID
PAID DATE
APPLIANCE REPAIR/ALTERATION PC
101-0000-42600
0
$4.77
$0.00
3 tF PAID BY : rf _ s so
n y METHOD ;^s
RECEIPT # A'
r :.si CHECK # x
%CLTD BY"'
Total Paid forMECHANICAL: $16.69 $0.00
DESCRIPTION
'AMOUNT,,;PAID,
` `° li
PAID: DATE`
WATER SYSTEM INST/ALT/REP
101-0000-42401
0
$11.92
$0.00
wr`< PAID BY K
r'e ; METHOD h t
t RECEIPT•#
'CHECK # I
CLTD BY
DESCRIPTION'
AACCOUNT a'=� ft
fQTY
_' 44 AMOUNT. ,:�
�a, PAID :'
PAID DATE
WATER SYSTEM INST/ALT/REP PC
101-0000-42600
0
$11.92
$0.00
�1 PAID BY
FfFMETHODIi'
F
RECEIPT
-. CHECK# '"
:,CLTD BY °
Total Paid for PLUMBING FEES: $23.84 $0.00
Al
<
'
R
w `<DESCRIPTION '
QAC OUN
+°
AMOUNT $
s:� PAID �§ .,,�
x PAID`DATE
zx-"`-•
sQTY
.*
��
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$64.35
$0.00
PAID BY ir'
>; ; 'METHOD{,¢ °
' RECEIPTx#� x"
_ CHECK # `.
CLTD BY,
�F.
r°
�aQTY
PAID DATEACCOUNTS
!
„""DESCRIPTION
F`
e..,PAID
.
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$51.48
$0.00
i` ten'$ if v era_ $
PAID BY
*"'METHOD"
' RECEIPT # x,
HE
CCK #
CLTI BY
.k ,,
DESCRIPTION)`" ° §f
e�A000UNT�
;_QTY
i$ AMOUNT�.,a F
�c `; `PAID ! (
PAID DATE
;1',' ,
i;r j j'
REMODEL, FIRST 100 SF
101-0000-42400
0
$48.62
$0.00
*, OAID:BY 3 = r
�` ° METHOD »R
{`RECEIPT # ;
Description:
40
Type: BUILDING, COMMERCIAL
Subtype: REMODEL Status:. APPROVED
Applied: 7/7/2014 KHE
Approved: 8/16/2014 JJO
Parcel No: 643200037 Site Address: 47900 WASHINGTON ST ST LA QUINTACA 92253
Subdivision: PM 31248
Block: Lot: 1
Issued:
Lot Sq Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $50,000.00.
Occupancy Type: Construction Type:
Expired:
No. Buildings: 0
No. Stories: 0, - No. Unites: 0
'AMOUNT
Details: INTERIOR REMODEL MODIFYING CASHWRAP AND FIXTURES, MINOR FLOORING REPLACEMENT AND RELATED ELEC. WORK.
PC 101-0000-42600 0 �2.40 �oO.00
Printed: Tuesday, August 26, 2014.11:32:59 AM 1 of 3 0?w-'YSTEMS
40
FINANCIAL
z
... INFORMATION
..... .... ... .....
PC 101-0000-42600 0 �2.40 �oO.00
Printed: Tuesday, August 26, 2014.11:32:59 AM 1 of 3 0?w-'YSTEMS
FINANCIAL
... INFORMATION
..... .... ... .....
. ..... . ....
'
.... . ................ .. . .......
-Tq
. . ....... 4" ........ ..
DESCRIPTION: i` i:
-'.ACCOUNT
'AMOUNT
PAID" AID DATE,
RECEIPT
`CHECK ETH
-�PA B Y*'',
"'BY
-vk,
BSAS SB1.473 FEE
101�-0000-20306
0
$2.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$2.00
$0. . 00
BSA:
DEVICES, ADDITIONAL
101-0000-42403
0
$9.52-
$0.00
DEVICES, ADDITIONAL
PC 101-0000-42600 0 �2.40 �oO.00
Printed: Tuesday, August 26, 2014.11:32:59 AM 1 of 3 0?w-'YSTEMS
I
7777
MOUNT-
'PAID
CLTD
DESCRIPTION
A
PAID
DATE,
RECEIPT
CHECK #;6
METHOD
-,PAID BY.
DEVICES, FIRST 20
101-0000-42403
0
$23.83
$0.00
DEVICES, FIRST 20 PC
101-0000-42600.
01
$2183
'$0.00
Total Paid forELECTRICAL: $59.58 $0.00
APPLIANCE
101-0000-42402
0
$11.92
$0.00
APPLIANCE
101-0.000-42600
$4.77
$0.00
REPAIR/ALTERATION PC
.0
Total Paid forMECHANICAL: $16.69 $0.00
WATER SYSTEM
101-0600-42401
.0
$11.92
$0.00
WATER SYSTEM
101-0060-42600
:6
$11'.92
$0.00
INST/ALT/REP PC
Total Paid forPLUMBING FEES: $23.84- .$0.00
,-REMODEL, EA
101m0000-42400
0
$64.35
$0.00
ADDITIONAL 500 SF
REMODEL, EA
101-0000-42600
0.,
$51.48
$0.60
A'DDITIOWAL 500 SF PC.
REMODEL, FIRST 100 SF
101-0000-42400
0
48:62
$0.00
REMODEL, FIRST 500 SF
101-0000-42600
$132.99
$0.00
PC
.0
Total Paid forREMODIEL: $297.44 $0.00
---FO
SMI -COMMERCIAL
101 -0000 -20308
$14.00
T_$0.00
Total Paid forSTRONG MOTION INSTRUMENTATION SMk $14.00 $0.00
I
BOND INFORMATION
ATTACH M E NTS
Printed: Tuesday, August 26, 2014 11:32:59 AM 3 of 3 EAJFCRUff
SYSH MS
Permit Number: BC0M2014=1002=----' .
Applied: 7/7/2014 Approved:
Issued: Finaled: ,
fStatus:.APPROVED.
Parent Permit:
Parent Project:
Details:
Description:
Site Address:47900 WASHINGTON_ST,ST_..�
City, State Zip Code: LA QUINTA, CA 92253
Applicant: <NONE>•
Owner: REALTY TRUST GROUP INC
Contractor: <NONE>
I
�? ,
Iti"L�.':NE}�"�,�^.Y.'i
{
{
Building Permit
Appllcadon�and Tracking Sheet
Project Address: *-79 0
Owner's None:,PA
A. P. Number. '
City•of b- Quinta
-
1003
Building of Safety Division
1 •
P.O., Box 1504,'78-49S title Tampico
La.Quinta, CA 92253 -{760) 777-7012 F
Building Permit
Appllcadon�and Tracking Sheet
Project Address: *-79 0
Owner's None:,PA
A. P. Number. '
Address: o (: !7T ;Ry_
Legal Description:
City, ST, Zip; : :(Roo'
Contractor: Tgtj
Address:
Telepliorie: 847-:1516,4&971
_Ptu0 Desoription: (' '
C , Zip:
elephonec
City Lic. #;'
Arch., Engr., Designer: (: ONIES
Address: l I 10 112111 AVE. N r=5lA tTE 500
City, ST, zip: a a.i.V(AV-_:,, LXA-• 98044
Teltiphone: 4?5.465.2004 .
State Lic. #: G — 3"19 2
Construction Type: •I Occupancy:
Project type (circle one): New Add'n .Aller. Repair Demo
Name of Contact Person:
Sq. Ft.:#
Stories: D # Units:
Telephone # of Contact Person:
Estimated Value Prolecto
h `i"CC APPLICANT: DO NOT WHITE BELOW THIS LINE
# Submittal
Req'd
Reed
TRACKING
PERMITFEES-
Plan Sets
Plan Check submitted-
Item Amount
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance
Title 24 Cales.Plans
picked up
'Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plea
.2" Review, ready for correctio sliasue
' G '
Electrical
Subcontactor List
Called Contact Person
PI ing
Grant Deed
Plans picked up
' H.OAL Approval
Plans resubmitted
Gading
IN HOUSE:-
'^' Reyiew; ready for eorreetions/inue
r
D •el er pact Fee
Planning Approval '
Called Contact Person
A .P.P.,
Pub. Wks. Appr •
Date of permit Issue
School Fees
_
Total Permit Fees