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BCOM2015-006978-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Ti4 4 4 QuiKro COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BCOM2015-0069 Property Address: 79795 HIGHWAY 111 APN: 600440010 Application Description: COSTCO / 497SF HEARING AID CENTER REMODEL Property Zoning: Application Valuation: $75,000.00 Applicant:� a HARVEYINC 9455 RIDGEHAVEN COURT STE 200 2016 SAN DIEGO, CA 92123 C,ITYG;:LA Q(�ryT COU„�p,�t!TYL�EJ�O�Ei�'OEf�,i�T��JT 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 Busi s and Professions Code, and my License is in full force and effect. License Class: B License No.: 866177 Date: D for Contractor: OWNER -BUILDER DECORATION I hereby affirm under penalty of perjury that I aml 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 ($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.). ( ) 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.). (_J 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 Lender's l 04 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS(760)777-7153 Date: 3/10/2016 Owner: COSTCO WHOLESALE CORP 999 LAKE DR ISSAQUAH, WA 92253 Contractor: HARVEYINC 9455 RIDGEHAVEN COURT STE 200 SAN DIEGO, CA 92123 (858)769-4000 Llc. No.: 866177 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' compe sation, as provided for by Section 3700 of the Labor Code, for the performance of th ork for which this permit is issued. I have and will maintain workers' compensation insurance, as required by S ction 3700 of the Labor Code, for the performance of the work for which this permit is issued. My orkers' compensatio ' suraan^nc�e.�carrier and policy number are: Carrier�O. policy Number: %J «Ob l I I certify that in the performance of the workkr 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 370 IF t Labor Code, I shall forthwith comply with those provisions. Date: 3 b Applicant: 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 PROVIDEDTOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official 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 infor ation is correct. I agree to comply with all city and county ordinances and state s ating to building construction, and hereby authorize representatives of this cit e r upon the above-mentioned property for inspection purposes. Date: 4b 3!. Signature (Applicant or -Agent): FINANCIAL INFORMATION DESCRIPTION' ACCOUNT QTY AMOUNT= PAID PAID DATE BSAS SB1473 FEE 101-0000-20306 0 $3.00 $3.00 3/10/16- /10/16PAID PAIDBY METHOD RECEIPT # CHECK # CLTD BY HARVEYINC CHECK R13767 16608 RSE Total Paid,for BUILDING STANDARDS ADMINISTRATION BSA: $3.00 $3.00 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 101-0000-42403 0 $24.17 $24.17 3/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY HARVEYINC CHECK R13767 16608 RSE DESCRIPTION ACCOUNT, QTY AMOUNT PAID PAID DATE DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $24.17 3/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY HARVEY INC CHECK R13767 16608 RSE Total Paid for ELECTRICAL: $48.34 $48.34 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE APPLIANCE REPAIR/ALTERATION 101-0000-02402 0 $24.18 $24.18 3/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY HARVEYINC CHECK R13767 16608 RSE DESCRIPTION ACCOUNT QTY AMOUNT. PAID PAID DATE APPLIANCE REPAIR/ALTERATION PC 101-0000-02600 0 $9.66 $9.66 3/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY HARVEYINC CHECK R13767 16608 RSE Total Paid for MECHANICAL: $33.84 $33.84 DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP 101-0000-42401 0 $12.09 $12.09 3/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY HARVEYINC CHECK R13767 16608 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAID DATE FIXTURE/TRAP PC 101-0000-42600 0 $12.09 $12.09 3/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY HARVEYINC CHECK R13767 16608 RSE DESCRIPTION ACCOUNT QTY AMOUNT. PAID PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-02401 0 $12.09 $12.09 3/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY HARVEYINC CHECK R13767 16608 RSE DESCRIPTION ACCOUNT QTY AMOUNT PAID PAIDDATE WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 $12.09 3/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY HARVEY INC CHECK R13767 16608 RSE Total Paid for PLUMBING FEES: $48.36 $48.36 DESCRIPTION ACCOUNT QTY AMOUNT- PAID PAID DATE REMODEL, FIRST 100 SF 101=0000-42400 0 $49.31 $49.31 3/10/16 - PAID BYMETHOD ;RECEIPT# CHECK# . CLTD BY HARVEYINC CHECK R13767 16608 RSE DESCRIPTION ACCOUNTQTY AMOUNT PAID PAID DATE REMODEL, FIRST 500 SF PC 101-0000-42600 0 $134.88 $134.88 3/10/16 PAID. BY- METHOD RECEIPT # = CHECK # CLTD BY HARVEYINC CHECK R13767 16608 RSE Total Paid for REMODEL: $184.19 $184.19 DESCRIPTION ACCOUNT . QTY AMOUNT., PAID PAID DATE SMI COMMERCIAL 101-0000-20308 0 $21.00 $21.00 3/10/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY HARVEYINC CHECK R13767 16608 RSE Total Paid for STRONG MOTION INSTRUMENTATION SMI: $21.00 $21.00 TOTALS: Permit Details PERMIT NUMBER � City of La Quinta BCOM2015 006911p ' Description: COSTCO / 497SF HEARING AID CENTER REMODEL Type: BUILDING, COMMERCIAL Subtype: REMODEL Status: APPROVED Applied: 12/28/2015 SGU Approved: 3/10/2016 RSE Parcel No: 600440010 Site Address: 79795 HIGHWAY 111 LA QUINTA,CA 92253 Subdivision: PM 33960 Block: Lot: 1 Issued: Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $75,000.00 Occupancy Type: Construction Type: Expired: No. Buildings: 0 . No. Stories: 0 No. Unites: 0 COMPLETION DATE Details: 497SF HEARING AID CENTER REMODEL/EXISTING CONSTRUCTION/NO CHANGE IN OCCUPANCY/FULLY SPRINKLED [COSTCO WHOLESALE] THIS PERMIT DOES NOT INCLUDE ADDITIONAL SQUARE FOOTAGE. 2013 CALIFORNIA BUILDING CODES. ADDITIONAL SITES Printed: Thursday, March 10, 2016 9:52:48 AM 1 of 3HAJF R Uff SYSTEMS CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES PLAN CHECK SUBMITTAL STEPHANIE GUMPERT 12/28/2015 12/28/2015 RECEIVED PHONED BAO PHAM (949) 705-0755 THAT PLANS ARE TELEPHONE CALL AJ ORTEGA 1/14/2016 1/14/2016 APPROVED BUT CONTRACTOR IS REQUIRED TO ACTIVE CITY BUSINESS LICENSE PRIOR TO ISSUANCE. CONDITIONS CONDITION DATE DATE DATE CONTACT TYPE ADDED- REQUIRED SATISFIED STATUS REMARKS NOTES READY TO ISSUE AJ ORTEGA 1/14/2016 CONTRACTOR REQUIRED TO OBTAIN/ACTIVE PENDING CHECKLIST CITY BUSINESS LICENSE PRIOR TO ISSUANCE. Printed: Thursday, March 10, 2016 9:52:48 AM 1 of 3HAJF R Uff SYSTEMS FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID, PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY BSAS SB1473 FEE 101-0000-20306 0 $3.00 $3.00 3/10/16 R13767 16608 CHECK HARVEY INC RSE Total Paid for BUILDING STANDARDS ADMINISTRATION $3.00 $3.00 CONTACTS DEVICES, FIRST 20 101-0000-42403 NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL r APPLICANT. HARVEY INC 9455 RIDGEHAVEN COURT STE 200 SAN DIEGO CA 92123 R13767 16608 CHECK CONTRACTOR HARVEY INC 9455 RIDGEHAVEN COURT STE 200 SAN DIEGO CA 92123 $24.18 $24.18 3/10/16 OWNER COSTCO WHOLESALE CORP 999 LAKE DR ISSAQUAH WA I 92253 FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT PAID, PAID DATE RECEIPT # CHECK # METHOD PAID BY CLTD BY BSAS SB1473 FEE 101-0000-20306 0 $3.00 $3.00 3/10/16 R13767 16608 CHECK HARVEY INC RSE Total Paid for BUILDING STANDARDS ADMINISTRATION $3.00 $3.00 BSA: DEVICES, FIRST 20 101-0000-42403 0 $24.17 $24.17 3/10/16 R13767 16608 CHECK HARVEY INC RSE DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 $24.17 3/10/16 R13767 16608 CHECK HARVEY INC RSE Total Paid for ELECTRICAL: $48.34 $48.34 APPLIANCE 101-0000-42402 0 $24.18 $24.18 3/10/16 R13767 16608 CHECK HARVEY INC RSE REPAIR/ALTERATION APPLIANCE REPAIR/ALTERATION PC 101-0000-42600 0 $9.66 $9.66 3/10/16 R13767 16608 CHECK HARVEY INC RSE Total Paid for MECHANICAL: $33.84 $33.84 FIXTURE/TRAP 101-0000-42401 0 $12.09 $12.09 3/10/16 R13767 16608 CHECK HARVEY INC RSE FIXTURE/TRAP PC 101-0000-42600 0 $12.09 $12.09 3/10/16 R13767 16608 CHECK HARVEY INC RSE WATER SYSTEM 101-0000-42401 0 $12.09 $12.09 3/10/16 R13767 16608 CHECK HARVEY INC RSE INST/ALT/REP WATER SYSTEM 101-0000-42600 0 $12.09 $12.09 3/10/16 R13767 16608 CHECK HARVEY INC RSE INST/ALT/REP PC Total Paid for PLUMBING FEES: $48.36 $48.36 REMODEL, FIRST 100 SF 101-0000-42400 0 $49.31 $49.31 3/10/16 R13767 16608 1 CHECK HARVEY INC RSE Printed:. Thursday, March 10, 2016 9:52:48 AM2 of 3 CR SYSTEMS BOND INFORMATION REVIEWS ATTACHMENTS REVIEW TYPE REVIEWER CLTD DESCRIPTION ACCOUNT CITY AMOUNT PAID PAID DATE RECEIPT # CHECK # METHOD PAID BY APPROVED 1ST BLDG STR (2 WK) AJ ORTEGA 12/28/2015 1/13/2016 1/14/2016 APPROVED DOING STRUCTUAL.IN HOUSE PER AJ. BY REMODEL, FIRST 500 SF 101-0000-42600 0 $134.88 $134.88 3/10/16 '1113767 16608 CHECK HARVEY INC RSE PC Total Paid for REMODEL: $184.19 $184.19 SMI -COMMERCIAL 101-0000-20308 0 1 $21.00 1 $21.00 1 3/10/16 1 R13767 1 16608 1 CHECK I HARVEY INC RSE Total Paid for STRONG MOTION INSTRUMENTATION SMI: $21.00 $21.00 TOTALS: BOND INFORMATION REVIEWS ATTACHMENTS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED DATE STATUS REMARKS NOTES IST BLDG NS (2 WK) AJ ORTEGA 12/28/2015 1/13/2016 1/14/2016 APPROVED 1ST BLDG STR (2 WK) AJ ORTEGA 12/28/2015 1/13/2016 1/14/2016 APPROVED DOING STRUCTUAL.IN HOUSE PER AJ. CALCULATIONS PROVIDED FOR SCOPE OF WORK, STAMPED AND SIGNED BY LICENSED ENGINEER BOND INFORMATION ATTACHMENTS Printed: Thursday, March 10, 2016 9:52:48 AM 3 of 3 C SYSTEMS.