BCOM2015-0021Applicant:
INTEGRITY CONSTRUCTION
2864 BURGUNDY LACE LANE
SAN JACINTO, CA 92582
IU-
12015
COM4f(IN/ �y�AUG 3OF(q
m _ilNtn
I BURGUNDY LACE LANE
JACINTO, CA 92582
(951)956-4236
Llc. No.: 904041
--------------------•-------------------------------------------------------------------------
ti
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 Professions Code,
and my License is in full force and effect.
License Class: B License No.: 904041
(� Date � -?/—IJ I Contractor.
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
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.).
( ) 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
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:_ Policy 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
comply with those provisions.
Date:��-��� / r 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 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, orcessation 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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: Is Signature (Applicant orAgentl
VOICE (760) 777-7125
78-495 CALLE TAMPICO
D
LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7011
COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 8/31/2015
Application Number:
BCOM2015-0021
Owner:
Property Address:
79775 HIGHWAY 111 105
P6K PORTFOLIO KDP
APN:
600440005
2301 ROSECRANS STE 2110
Application Description:
KOMAR/DICKIE'S BBQ/1ST
REVISION/HOOD DU ENSIP}�) EL SEGUNDO, CA 92253
Property Zoning:
0 �
Application Valuation:
$9,952.00
�_� n
Applicant:
INTEGRITY CONSTRUCTION
2864 BURGUNDY LACE LANE
SAN JACINTO, CA 92582
IU-
12015
COM4f(IN/ �y�AUG 3OF(q
m _ilNtn
I BURGUNDY LACE LANE
JACINTO, CA 92582
(951)956-4236
Llc. No.: 904041
--------------------•-------------------------------------------------------------------------
ti
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 Professions Code,
and my License is in full force and effect.
License Class: B License No.: 904041
(� Date � -?/—IJ I Contractor.
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
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.).
( ) 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
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:_ Policy 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
comply with those provisions.
Date:��-��� / r 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 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, orcessation 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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter upon the above-
mentioned property for inspection purposes.
Date: Is Signature (Applicant orAgentl
FINANCIAL • •
DESCRIPTION ACCOUNT. QTY AMOUNT
PAID
PAID DATE
BSAS SB1473 FEE 101-0000-20306
0 $1.00
$1.00
5/27/15
PAID BY METHOD
RECEIPT #
CHECK #
CLTD BY
PALM SPRINGS BBQ INC. CHECK
R6449
1098
SKH
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $1.00. $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
APPLIANCES, NON -RES
101-0000-42403
0
$24.17
$24.17
5/27/15
PAID BY
•METHOD
RECEIPT #
CHECK #
CLTD BY
PALM SPRINGS BBQ INC.
CHECK
R6449
1098
SKH
DESCRIPTION .
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE.
APPLIANCES, NON -RES
101-0000-42403
0
$24.17
$24.17
5/27/15
PAID BY
METHOD
RECEIPT #
CHECK• #
CLTD BY
PALM SPRINGS BBQ INC.
CHECK
R6449
1098
SKH
DESCRIPTION
ACCOUNT
QTY
AMOUNT"
PAID
PAID DATE
APPLIANCES, NON -RES PC
101-0000-42600
0
$24.17
$24.17
5/27/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
PALM SPRINGS BBQ INC.
CHECK
R6449
1098
SKH
DESCRIPTION
' ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
APPLIANCES, NON -RES PC
101-0000-42600
0
$24.17
•$24.17
5/27/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
PALM SPRINGS BBQ INC..
CHECK
R6449
1098
SKH
Total Paid forELECTRICAL: $96.68 $96.68
DESCRIPTION
ACCOUNT.
QTY
AMOUNT
PAID
PAID DATE
EXHAUST HOOD
101-0000-42402
0
$24.18
$24.18
5/27/15
PAID BY
METHOD
RECEIPT•#
CHECK #
CLTD BY
PALM SPRINGS BBQ INC.
CHECK
R6449
1098
SKH
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
EXHAUST HOOD PC
101-0000-42600
0
$9.66
$9.66
5/27/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
PALM SPRINGS BBQ INC.
CHECK
R6449
1098
SKH
Total Paid forMECHANICAL: $33.84 $33.84
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
REMODEL, FIRST 100 SF,
101-0000-42400
0
$49.31
$49.31
5/27/15
PAID.BY
METHOD
RECEIPT #
CHECK #
CLTD BY
PALM SPRINGS BBQ INC.
CHECK
R6449
1098
SKH
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$134.88
$134.88
5/27/15
PAID BY
METHOD
RECEIPT #
CHECK #
CLTD BY
PALM SPRINGS BBQ INC.
CHECK
R6449
1098
SKH
Total Paid for REMODEL: $184.19 $184.19
DESCRhTION
ACCOUNT.
QTY
AMOUNT
PAID
PAID DATE'
SMI - COMMERCIAL
101-0000-20308
0
$2.79
$2.79
5/27/15
` PAID BY.
METHOD
RECEIPT #
CHECK #
CLTD BY
PALM SPRINGS BBQ INC.
CHECK
R6449
1098
SKH
Total Paid forSTRONG MOTION INSTRUMENTATION SM! $2.79 $2.79
0
Description: KOMAR/DICKIE'S BBQ/1ST REVISION/HOOD DUCT EXTENSION
Type: BUILDING, COMMERCIAL
Subtype: REMODEL Status: ISSUED
Applied: 4/16/2015 SKH
Approved: 4/23/2015 JJO
Parcel No: 600440005 Site Address: 79775 HIGHWAY 111 10SLA QUINTA,CA 92253
Subdivision: PM 036269
Block: Lot: 5
Issued: 8/31/2015 MFA
Lot Scl Ft: 0
Building Sq Ft: 0 Zoning:
Finaled:
Valuation: $9,952.00
Occupancy Type: Construction Type:
Expired: 2/27/2016 MFA
No. Buildings: 0
No. Stories: 0 No. Unites: 0.
4/16/2015
Details: ADD AND ENLARGE KITCHEN HOODS. 2013 CALIFORNIA BUILDING CODES.
130
I�7
., Applied to Approved
Approved to Issued
ADDITIONAL
CHRONOLOGY
CHRONOLOGY TYPE
STAFF NAME
ACTION DATE
COMPLETION DATE
NOTES
NOTE
STEPHANIE KHATAMI
S/27/2015
5/27/2015
PAID FOR BUT NOT ISSUED.
PLAN CHECK.SUBMITTAL
STEPHANIE KHATAMI
4/16/2015
4/16/2015
RECEIVED
CALLED WILL HUGES TO GET ESTIMATED VALUATION FOR
TELEPHONE CALL
JIM JOHNSON
4/23/2015
4/23/2015
PERMIT FEES. WILL CALL BACK WITH PRICE.
AS OF 12:14 4/28/2015 NO CALL BACK WITH PRICE
TELEPHONE CALL
JIM JOHNSON
5/1/2015
5/1/2015
CALLED TYSON @ 307-921-4790 TO INFORM HIM PLANS ARE
READY TO ISSUE
CONDITIONS
Printed: Monday, August 31, 2015 4:22:30 PM 1 of 3
�U%jti iJ LJ /w�(w. SYSTEMS
Permit Details PERMIT NUMBER
L'.
21$
City of La Quinta BCOM201500,
CONTACTSmid
FINANCIAL
CITY
STATE
ZIP
PHONE
FAX
EMAIL
NAME TYPE
NAME _
ADDRESSI
APPLICANT
INTEGRITY CONSTRUCTION
2864 BURGUNDY LACE
LANE
SAN JACINTO
CA
92582
INC.
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
CONTRACTOR
INTEGRITY CONSTRUCTION
2864 BURGUNDY LACE
LANE
SAN JACINTO
CA
92582
R6449
1098
CHECK
OWNER
P6K PORTFOLIO KDP
2301 ROSECRANS STE
2110
EL SEGUNDO
CA
92253
FINANCIAL
INFORMATION
CLTD
DESCRIPTION ACCOUNT QTY AMOUNT
PAID
PAID DATE RECEIPT # CHECK # METHOD PAID BY
By .
BSAS SB1473 FEE 101-0000-20306 0 $1.00
$1.00
5/27/15 R6449 1098 CHECK PALM SPRINGS BBQ SKH
INC.
Total Paid for BUILDING STANDARDS ADMINISTRATION $1.00 $1.00
BSA:
APPLIANCES, NON -RES
101-0000-42403
0
$24.17
$24.17
5/27/15
R6449
1098
CHECK
PALM SPRINGS BBQ
SKH
INC.
APPLIANCES, NON -RES
101-0000-42403
0
$24.17
$24.17
5/27/15
R6449
1098
CHECK
PALM SPRINGS BBQ
SKH
INC.
APPLIANCES, NON -RES
101-0000-42600
0
$24.17
$24.17
5/27/15
R6449
1098
CHECK
PALM SPRINGS BBQ
SKH
PC
I
IINC.
APPLIANCES, NON -RES
101-0000-42600
0
$24.17
$24.17
5/27/15
R6449
1098
CHECK
PALM SPRINGS BBQ
SKH
PC
INC.
Total Paid for ELECTRICAL: $96.68 $96.68
EXHAUST HOOD
101-0000-42402
0
$24.18
$24.18
5/27/15
R6449
1098
CHECK
PALMI SPRINGS BBQ
SKH
INC.
EXHAUST HOOD PC
101-0000-42600
0
$9.66
$9.66
5/27/15
R6449
1098
CHECK
PALM SPRINGS BBQ
SKH
INC.
Total Paid forMECHANICAL: $33.84 $33.84
REMODEL, FIRST 100 SF
101-0000-42400
0
$49.31
$49.31
5/27/15
R6449
1098
CHECK
PALM SPRINGS BBQ
SKH,
INC.
Printed: Monday, August 31, 2015 4:22:30 PM 2 of 3 J
SYS TENTS
Printed: Monday, August 31, 2015 4:22:30 PM 3 of 3
SYSTEti1S
y
._..............
CLTD
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PAID
PAID DATE
RECEIPT #
CHECK #
METHOD
PAID BY
BY
REMODEL, FIRST 500 SF
101-0000-42600
0
$134.88
$134.88
5/27/15
R6449
1098
CHECK
PALM SPRINGS BBQ
SKH
PC
INC.
Total Paid for REMODEL: $184.19 $184.19
SMI - COMMERCIAL
101-0000-203080
$2.79
$2.79
5/27/15
R6449
1098
CHECK
PALM SPRINGS BBQ
SKH
INC.
Total Paid forSTRONG MOTION INSTRUMENTATION SMt $2.79 $2.79
TOTALS:
Printed: Monday, August 31, 2015 4:22:30 PM 3 of 3
SYSTEti1S
August 31, 2015
To whom it may concern,
I lee Smith with Integrity Construction authorize a representative from CIS to pick up on my behalf the
required permit for the Dickeys Barbeque Pit Restaurant located at 79775 Highway 111 LaQuinta Ca
92253
Should you have any questions or comments, please don't hesitate to ask.
Thank You.
Lee Smith
Integrity Construction Co
rr
integrityconstructionco@vahoo.com
951-956-4236
ok)
Bin #
PAWAJF— City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet
Permit #
�W?v �"
Project Address: "1Gi _ 1' H 1 i�
Owner's Name:
A. P. Number:
Address: "1C1 _ )� 111
Legal Description:
City, ST, Zip: UA (U n�tyl CA 'q).�53
Contractor: ,r
Telephone:
Address: AbUl
Project Description:
City, ST, Zip: AJ 3 C ,^ITQ C.A. Gl)"sn—
960JIO
Telephone:
hone:
State Lic. # : 9DLIOHI
City Lic. #:
Arch., Engr., Designer:
Address: 1 I UI A QG L1
City, ST, Zip:
e. y�
CoelePho n structi n TY P e: Occupancy: �
-2
State Lic. #:
Project type (circle one . New Add'n Alter Repair Demo
Name of Contact Person: W I U
Sq. Ft.: Z # Stories:
# Units:
Telephone # of Contact Person: (�
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready f corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electrical
Subeontactor List
Called Contact Person
Plumbing .
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'"' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
n��or�6