06-3567 (RC)n
y P.O. BOX 1504 4
^�
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Application Number: .
Property Address:
APN:
Application description:
Property Zoning:
Application valuation:
Applicant:
06-00003567 J
51555 DESERT CLUB DR
770-182-001- -
REMODEL - COMMERCIAL
VILLAGE COMMERCIAL
10000
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 11/15/06
Owner:
STE 450 KELLY JAMES F
NOV 20 20065N,
Contractor:
Architect or Engineer: KELLY PACIFIC COSTT
100 DRAKE'S LANDING'
GREENBRAE, CA 94904
(415)464-0900
Lic. No.: 346196
-----------------------------------------------
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 License is in full force and effect.
License Class.,B License No.: 346196
ate: /� ( 7o� ntractor:
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 for a permit subjects the applicant to a civil penalty of not more than five hundred dollars 1$5001.:
(_ 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 —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 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: if M
L'ender's Address:
LQPER11fIT
---------------
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.
1 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 STATE FUND Policy Number 0001375-2006
_ I certify that, in the performance of the work for which this permit is issued, 1 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
370,of the or Code, I shall fo/rtthhw/ith comp with hose provisions.
"elte: ` OST Dpplicant:
WARNING: FAILURE TO SECUR ORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO - IMINAL 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.
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 is correct. I agree to comply with all
city and ounty ordinances and state laws relating to building construction, and hereby authorize representatives
oft ��'
upon th ove-mentioned property for inspe tiot ses.
Date: ature (Applicant or Agent):
Application Number . . . . . 06-00003567
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 117.00 Plan Check Fee
76.05
Issue Date . . . . Valuation
10000
Expiration Date 5/14/07
Qty Unit Charge Per
Extension
BASE FEE
45.00
8.00 9.0000. THOU BLDG 2,001-25,000 _
----------------------------------------------------------------------------
72.00
Permit ELECT - ADD/ALT/REM
Additional desc .
Permit Fee. . . . . 54.84. Plan Check Fee
13.71
Issue Date . . . . Valuation
0
Expiration Date 5/14/07
Qty Unit Charge Per
Extension
BASE FEE
.
15.00
747.00 .0200 ELEC GARAGE OR NON-RESIDENTIAL
14.94
20.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20
15.00
22.00 .4500 EA ELEC DEVICE/FIXTURE >20
------------------------------=--=---------------------------------=--------
9.90
Permit MECHANICAL
Additional desc .
Permit Fee . . . . 19.50 Plan Check Fee
4.88.
Issue Date Valuation
0
Expiration Date 5/14/07
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 4:5000 EA MECH VENT INST/ DUCT ALT
4.50
----------------------------------------------------------------------------
Special Notes and'Comments.
747 SF TENANT
IMPROVEMENT/8-OL/B-OCC../V-NR SHELL.
DESERT. SOUTHWEST INSURANCE BROKERS.
November 15, 2006 11:57:46 AM AORTEGA
-------------------------------------=--------------------------------------
Other Fees . . . . . . . . . STRONG MOTION (SMI) - COM
_
2.10
Fee summary Charged Paid Credited
Due
---------------------------------------------------------
Permit Fee Total 191.34 .00 .00
191.34
Plan Check Total 94.64 .00 .00
94.64
Other Fee Total 2.10 .00 .00
2.10 '
LQPERA4IT
Application Number . . . . . 06-00003567
Grand Total 288.08 .00 .00 288.08
LQPERAIIT .
.1
LQPERAIIT .
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of.
Banning
.;
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
4.
Indian Wells
Indio
*e Elsinore
3
�... Quinta
.;.
Moreno Valley
4.
Palm Desert
Perris
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
JeffStone,
District 3
Roy Wilson,
District 4
Marion Ashley,
District 5
4�1 -.-I.- - 17 MW
RIVERSIDE COUNTY,
FIRE DEPARTMENT
210 West San Jacinto Avenue . Perris, California 92570 • (951) 940-6900 • Fax (951) 940-6910
Date I I --; 9'
Building Department
The Riverside County Fire epartm nt is grantint e Fire clearance for the f llowin
location SoU Cervt ��j�555TiSe�!_ C�u P
Please cal if you should have questions 760-863-8886•-'
Res ctfully
By
Fire Systems Inspector
,- Certificate of Occ'upanc Y
j.`KC.OtFD0.1hD �� .
G� OF 9► Y p Building & Safety Department -
This Certificate is issued pursuant to the requirements of Section 109 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 DRIVE (STE #450)
'
k
i
a
Use classification: OFFICE (DESERT SOUTHWEST INS. BROKERS INC. Building Permit No.: 06-3567
Occupancy Group: B Type of Construction: VN Land Use Zone: VC
Owner of Building: JAMES F. KELLY Address:
By: STEVE TRAXEL
—1—.4, Date: 12-13-2006
Building Official
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