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10-1052 (RC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number:_ Property Address: APN: Application description Property Zoning: Application valuation: A c&t�v.. 4 4v Q" "10-00001052 51555 DESERT CLUB DR STE 300 770-182-001- - REMODEL - COMMERCIAL VILLAGE COMMERCIAL 25000 Architect or Engineer: af� 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 of the Business and Professional ode and my License is in full force and effect. License Class: BB is n No 346196 Date:O ontractor: OWNER -BUILD ECLARATION I hereby affirm under penalty of perjury that I am exempt fro a Contractor's State License Law for the following reason ISec. 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).: (_ 1 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 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: 19 Lender's Address: I LQPERMIT Owner: KELLY JAMES F Contractor: KELLY PACIFIC CONSTRUCTI 999 ANDERSEN DR, #160 SAN RAFAEL, CA 94901 (415)464-0900 Lic. No.: 346196 VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 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 GRANITE INS Policy Number WC009777521 _ 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 sub' t to the0,oeors' compensation laws of California, and agree that, if I should b eOme subje ttle� cmpensationprovisions of Section 3700 of the Labor Code shall f rt co ply ose provisions. WARNING: FAILURE TO SEVAE WORKERS' COM PEN SATIO COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER CRIMINAL PENALTIES AND CAL 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 i ormation' rrect. aKerec.0 mply with all city an county ordinances and state laws relating to building struction here au resentatives of s county o e ter upon [ above-mentioned propert mspectio rpo s Si ature (Applicant or Agent): Application Number . . . . . 10-00001052 LQPERMIT Structure Information Construction Type . . . . . TYPE V, UNPROTECTED Occupancy Type . . . . BUSINESS <50 Other struct.info . . . . . CODE EDITION 2007/08 ENERGY FIRE SPRINKLERS YES OCCUPANT LOAD 17.00 ----------------------------------------------------'------------------------ 2ND FLOOR SQUARE FOOTAGE 1694.00 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 252.00 Plan Check Fee 163.80 Issue Date . . . .Valuation . . . . 25000 Expiration Date 5/07/11 Qty Unit Charge 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 52.95 Plan Check Fee 13.24 Issue Date Valuation 0 Expiration Date 5/07/11 Qty Unit Charge .Per Extension BASE FEE 15.00 20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 15.00 51.00 .4500 ----7-------------------7--------------------------------------------------- EA ELEC DEVICE/FIXTURE >20 22.95 Permit . . . MECHANICAL Additional desc . Permit Fee . . . . 39.50 Plan Check Fee 9.88 Issue Date . . . . Valuation. . . . . 0 Expiration Date 5/07/11 Qty Unit Charge Per Extension BASE FEE 15.00 4.00 4.5000 EA MECH VENT INST/ DUCT.ALT 18.00 1.00 6.5000 ---------------------------------------------------------------------------- EA MECH VENT FAN 6.50 Permit . . . PLUMBING Additional desc . Permit Fee . . . . 39.00 Plan Check Fee 9.75 LQPERMIT Application Number . . . . . 10-00001052 Permit . . . . . . PLUMBING Issue Date . . . . Valuation .0 Expiration Date 5/07/11 Qty Unit Charge Per Extension BASE FEE 15.00 3.00 6.0000 EA PLB FIXTURE 18.00 1.00 3.0000 EA PLB-WATER INST/ALT/REP -3.00 1.00 3.0000 EA PLB FIXTURE DRAIN/VENT REP/ALT 3:00 ---------------------------------------------------------------------------- Special Notes and Comments INTERIOR OFFICE T. -I. 1694 SF SUITE 300. 2007 CODES 2008 ENERGY. TENANT: STRACTS INC. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . ACCESSIBILITY PLAN REVIEW 16.38 _ BLDG STDS ADMIN (SB1473) 1.00 ENERGY REVIEW FEE 16:38 Fee summary Charged Paid Credited Due Permit Fee Total 383.45 .00 .00 38.3.45 Plan Check Total 196.67 .00 .00 196.67 Other Fee Total 33.76 .00 .00 33.76 Grand Total 613.88 .00 .00 613.88 LQPERMIT Certificate of Occupancy 4 412" Building & Safety Department This Certificate is issued pursuant to the requirements of Appendix Chapter 1 Section 110 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. BUILDING ADDRESS: 51-555 DESERT CLUB DR, SUITE 300 Use classification: COMMERCIAL — STRACTS, INC. Occupancy Group: B Type of Construction: VB Code Edition: 2007/2008 Sprinkler Installed: YES Building Official Building Permit No.: 10-1052 Land Use Zone: VC Occupant Load: 17 Owner of Building: KELLEY DOMER DEV Address: 999 ANDERSON DR, SUITE 160 City, ST, ZIP: SAN RAFAEL, CA 94901 By: STEVE TRAXEL Date: DECEMBER 27, 2010