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04-5561 (RC)p � f C1 � idCiE OE,p'6. r BUILDING & SAFETY DEPARTMENT s P.O. BOX 1504 (760).777-7012 OF f19 78-495 CALLE TAMPICO FAX (7'60) 777-7011 LA. QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . 04--00005561 Date 9/01/04 Property Address . . . . . . 506.60 EISENHOWER DR REC BLDG APN: 773-370-02;8-3 _000000 - Tenant nbr, name . . . . . . REC'BLDG REV &MAIL KIOSK Application description . . . REMODEL - COMMERCIAL Property Zoning . . . . . . . LOW DENSITY RESIDENTIAL Application valuation . . . . 22186 Own6r Contractor LANDAQ INC LUCAS GENERAL. CONTRACTING CORP 55920 PGA BLVD 1111 QUAIL STREET LA-QUINTA CA 92'253 PALM DESERT CA 9.2260 (9.0.9) 474-0221 WCC: STATE FUND 01/01/05 WC: 1714.988 01/01/05 CSLB: 758785 02:/28,/05 CCC- B --------------------------- Structure Information ---------------------•---- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . ASSYG NO STAGE Flood Zone . . . ,BLDG ZONE AO . . . FLOOD Other struct info,. CODE EDITION 2001 FIRE SPRINKLERS YES MIXED-USE OCCUPANCY A3/B OCCUPANT LOAD 78.00 FIRST FLOOR SQ FTG 499.00 Permit . . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 234.00 Plan Check Fee 152.1.0 Issue. Date . . . . Valuation . . . . 22186 Qty Unit Charge Per Extension BASE FEE 45.00 21.00 9.0000 THOU BLDG 2.,001-25,000 189.00 ---------------------------------------------------------------------------- Permit ... . ELECT - ADD/ALT/REM Additional desc . Permit'Fee 24..98 Plan Check Fee 6.25 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 .4 P.O. Box 151)4 VOICE ,(760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 Application Number: Applicant: Applicant's Mailing,Address: BUILDING & SAFETY DEPARTMENT Date: Architect or Engineer: Architect or E g' r' Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of pedUrythat I am Iicensed,under provisions,of Chapter.9 (commending'with Section 7000) of Division 3 of the Business and 'Professionals- Code,and myLicen s in full force and effect. License Class License No. <–I? % 9--S_ r OWNER -BUILDER DECLARATION I hereby affirm, under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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 _alleged exemption: Any violation oi5ection 7.031:5 by any applicant fora pernit subjects _ the applicant to a civir penalty of. not more than five hundred dollars ($500).): (; 'I, as ownerof.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 or 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:). U I; as -.owner of the property, am exclusivelyc8ntracting with licensed contractorsto 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.). U I am exempt under Sec. BA PZ. for this reason Date Owner WORKERS' COMPENSATION. DECLARATION 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 Sectiom3700 of the Labor Code, for the'perfonnance of the work for which this permit is issued. —i have and will maintain workers' compensation insurance, as required by Section 3700 ofthe. Labor Code, for the performance of the work for which this perm is ,c issued. My ye*ers' compensation insurance,carier,a rp. Cartier Policy Number / � CY —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. Date Applicant �— WARNING: FAILURE TO SECURE WORKERS' COMPENS ION 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 THECOST OF COMPENSATION, DAMAGES AS PROVIDED FORJN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY f hereby affirm under penalty of perjurythatthere is;a constructiorrlending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.); Lender's Name Lender's Address 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 Quints, its officers, agents and employees' forany act or omission related to the work being performed under or following issuance of this permit. Z 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 thatt 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 county to enter upon thea ntio dd property for inspection purposes. Date / I Signature (Applicant or Agent):., Fee summary Charged Permit Fee Total 293.48 Plan Check Total 166.98 Other Fee Total 19.86 Grand Total 480.32 Paid Credited Due .0.0 .00 293.48 .00 .00 166.98 .00 .00 19.86 ..00 .00 48'0.32 Page 2 Application Number . . . . . 04-00005561 Date 9/01/04 Qty Unit Charge Per Extension 499..00 .0200 ELEC GARAGE OR NON-RESIDENTIAL 9.98 Permit . . . . . . MECHANICAL Additional desc . Permit Fee . . . . 19.50 Plan Check Fee 4.88 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 4.5.000 EA MECH VENT INST/ DUCT ALT 4.50 ----------------------------------------------------------------------------------- Permit . . . . . . PLUMBING Additional' desc . .. Permit Fee . . . . 15.00 Plan Check Fee 3.75 Issue Date . . . . 'Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 Special Notes and Comments COMMERCIAL - REVISION TO RECREATION BUILDING (PERMIT #0306-234)UNDER CONSTRUCTION. ADDITIONS: 344 SQ.FT. BUILDING INTERIOR, 155 SQ.FT. MAIL KISOK(EXTERIOR) A-3 OCC. TYPE V -N CONSTRUCTION. 2.001 CODES Other Fees . . . . . . . ENERGY REVIEW FEE 15.2.1 STRONG MOTION (SMI) - COM 4.6:5 Fee summary Charged Permit Fee Total 293.48 Plan Check Total 166.98 Other Fee Total 19.86 Grand Total 480.32 Paid Credited Due .0.0 .00 293.48 .00 .00 166.98 .00 .00 19.86 ..00 .00 48'0.32