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BDEM2016-000178-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 T4'tf 4 stPQ" COMMUNITY DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BDEM2016-0001 Property Address: 78085 AVENIDA LA FONDA APN: 770122003 Application Description: FORTUN / INTERIOR DEMOLITION ONLY Property Zoning: Application Valuation: Applicant: DOUG WALL CONSTRUCTION INC F 78450 AVENUE 41 AN 12 ?0i0 BERMUDA DUNES, CA 92203 ,ITVOFLP QUINTR TY DEVELOWENT DEPARTtiTNT 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: BiC-9. A. 7. C10 License.Ne.,043112 ,Date: ! Contractor 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 ($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 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.). U 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: Lender's Add 11111111111111111111 59 VOICE (760) 777-7125 FAX(760)77 7-7011 INSPECTIONS (760) 777-7153 Date: 1/12/2016 Owner: FORTUNE PROP 5800125TH LN NE KIRKLAND, WA 92253 Contractor: DOUG WALL CONSTRUCTION INC 78450 AVENUE 41 BERMUDA DUNES, CA 92203 (760)772-8446 Llc. No.: 743112 WORKER'S COMPENSATION DECLARATION I hereby irm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' co tion, as provided for by Section 3700 of the Labor Code, for the performance �hw or which this permit is issued. have and will maintain workers' compensation insurance, as required by of the Labor Code, for the performance of the work for which this permit y workers' compensation insurance carrier and policy number are: Carrier: _ Polity 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 complywith t se pro cions. Date: Applicant: WARNING: FAILURE TO SECURE WORK E COMPENSATI C ERAGE 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. 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 b 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-m7Z2 d pro erty for inspection purpos Date: �� Signature (Applicant or Age DESCRIPTION FINANCIAL ACCOUNTCITY a. AMOUNT PAID PAID DATE DEMOLITION, INTERIOR 101-0000-42404 0 $36.26 $36.26• 1/12/16 PAID BY METHOD RECEIPT # CHECK # CLTD BY FORTUNE PROP CHECK R12068 7902 AOR DESCRIPTION ACCOUNT QTY AMOUNT : PAID PAID DATE DEMOLITION, INTERIOR PC 101-0000-42600 0 $97.17 $97.17 1/12/16 PAID BY METHOD w RECEIPT # .- CHECK # CLTD BY . FORTUNE PROP- CHECK R12068 7902 AOR Total Paid for DEMOLITION: $133.43 $133.43 TOTALS: $133.43 $133.43 .X Description: FORTUN / INTERIOR DEMOLITION ONLY Type: DEMOLITION Subtype: COMMERCIAL/OTHER Status: ISSUED Applied: 1/12/2016 AOR Approved: 1/12/2016 AOR Parcel No: 770122003 Site Address: 78085 AVENIDA LA FONDA LA QUINTA,CA 92253 Subdivision: DESERT CLUB TR UNIT 4 Block: Lot: 7 Issued: 1/12/2016 AOR Lot Sq Ft: 0 Building Sq Ft: 0 Zoning: Finaled: Valuation: $0.00 Occupancy Type: Construction Type: Expired: 7/10/2016 AOR No. Buildings:.O No. Stories: 0 No. Unites: 0 ACTION DATE Details: INTERIOR DEMOLITION OF EXISTING RESTAURANT ONLY. THIS PERMIT DOES NOT INCLUDE LOAD BEARING CONSTRUCTION, WORK THAT WILL BE VISIBLE FROM THE EXTERIOR OF THE BUILDING OR FRAMING, ELECTRICAL, MECHANICAL OR PLUMBING INSTALLATIONS. PRIOR TO OCCUPANCY A SEPARATE PERMIT FOR OCCUPANCY IS REQUIRED. 2013 CALIFORNIA BUILDING CODES Printed: Tuesday, January 12, 2016 3:42:03 PM 1 of 2 CN? srsrcnns CHRONOLOGY CHRONOLOGY TYPE STAFF NAME ACTION DATE COMPLETION DATE NOTES PLAN CHECK SUBMITTAL RECEIVED AJ ORTEGA 1/12/2016 1/12/2016 APPLICANTION SUBMITTED, REVIEWED AND APPROVED - SEE MISCELLANEOUS NOTES CONDITIONS CONTACTS NAME TYPE NAME ADDRESSI CITY STATE ZIP PHONE FAX EMAIL APPLICANT DOUG WALL CONSTRUCTION INC 78450 AVENUE 41 BERMUDA DUNES CA 92203 CONTRACTOR DOUG WALL CONSTRUCTION INC 78450 AVENUE 41 BERMUDA DUNES CA 92203 OWNER FORTUNE PROP 5800 125TH LN NE KIRKLAND WA 92253 Printed: Tuesday, January 12, 2016 3:42:03 PM 1 of 2 CN? srsrcnns Printed: Tuesday, January 12, 2016 3:42:03 NA 2 of 2 C SYS7EtitS REVIEWS REVIEW TYPE REVIEWER SENT DATE DUE DATE RETURNED STATUS REMARKS NOTES DATE Printed: Tuesday, January 12, 2016 3:42:03 NA 2 of 2 C SYS7EtitS