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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