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BCOM2016-0018i �- 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BCOM2016-0018 Property Address: 47875 CALEO BAY STE,101 APN: 643200038 Application Description: PHAN / CALEO BAY ORTHODONTICS Property Zoning: Application Valuation: $125,000.00 Applicant: GABRIEL LUJON 36947 COOK ST STE 104 PALM DESERT, CA 92253 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.: 669244 Da,�_ Contra o . V OWNER -BUIL R 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 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.). (1 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 Name: ` Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/8/2016 Owner: CALEO BAY P 0 BOX 13230 PALM DESERT, CA 92253 Contractor: BRADLEY -JORDAN CONSTRUCTION COMPANY INC PO BOX 3428 FULLERTON, CA 92834 (714)356-1203 Llc. No.: 669244 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 thprork for which this permit is issued. ( I have and will maintain workers' compensation insurance, as required by 5ion 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9053224 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 t abor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE WORKER 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, 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 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:, -7M Signature (Applicant or Agen r v Date: 8/8/2016 Application Number: BCOM2016-0018 Owner:. Property Address: 47875 CALEO BAY STE 101 CALEO BAY APN: 643200038 P 0 BOX 13230 Application Description: PHAN / CALEO BAY ORTHODONTICS PALM DESERT, CA 92253 Property Zoning: Application Valuation:' $125,000.00 Applicant:. -Contractor: GABRIEL LUJON BRADLEY -JORDAN CONSTRUCTION COMPANY INC 36947 COOK ST STE 104 y PO BOX 3428 PALM DESERT, CA 92253 FULLERTON, CA 92834 (714)356-1203 Llc. No.: 669244 --------------------------------------,----------=-------------------------------------------- Detail:"2363 SF INTERIOR TENANT IMPROVEMENT FOR "cALEO bAY ORTHODONTICS" IN SUITE 101. TYPE VB W. FIRE SPRINKLER, "B" OCCUPANCY, 24 OCCUPANT LOAD. 2013 CODES: } DESCRIPTION ACCOUNT. QTY AMOUNT ART IN PUBLIC PLACES- COMMERCIAL REMOD 270-0000-43201 0 $125.00 Total Paid for ART IN PUBLIC PLACES - AIPP: $125.00 DESCRIPTION ACCOUNT QTY AMOUNT BSAS 561473 FEE - 101-0000-20306 0 $5.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $5.00 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, ADDITIONAL 101-0000-42403 0 $413.82 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, ADDITIONAL PC 101-0000-42600 0 $102.60 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $24.17 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST•20 PC 101-0000-42600 0 $24.17 Total Paid for ELECTRICAL: $564.76• DESCRIPTION ACCOUNT QTY AMOUNT OTHER MECHANICAL EQUIPMENT 101-0000-42402 0 $36.26 DESCRIPTION ACCOUNT QTY AMOUNT OTHER MECHANICAL EQUIPMENT PC 101-0000-42600 0 $36.26 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $12.09 Total Paid for MECHANICAL: $84.61 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $36.27 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $36.27 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $7.25 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 Total Paid for PLUMBING FEES: $116.06 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, EA ADDITIONAL 500 SF • 101-0000-42400 0 $108.75 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $87.00 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, FIRST 100 SF 101-0000-42400 0 $49.31 DESCRIPTION ACCOUNT CITY AMOUNT REMODEL, FIRST 500 SF PC 101-0000-42600 0 $134.88 Total Paid for REMODEL: $379.94 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: Application Description: Property Zoning: Application Valuation: Applicant: GABRIEL LUJON 36947 COOK ST STE 104 PALM DESERT, CA 92253 T-, d4t. 4 4 Q" DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT BUILDING COMMERCIAL/REMODEL BCOM2016-0018 47875 CALEO BAY STE 101 643200038 PHAN / CALEO BAY ORTHODONTICS $125,000:00 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: B License No.: 669244 Date 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 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.). (_) 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 Addref Clopy. . VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS(760)777-7153 Owner: CALEO BAY P 0 BOX 13230 PALM DESERT, CA 92253 Date: 9/21/2017 I1�*Qc( S(FII� f/ Contractor: BRADLEY -JORDAN CONSTRUCTION COMPANY INC PO BOX 3428 FULLERTON, CA 92834 (714)356-1203 LIC. No.: 669244 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: STATE COMPENSATION INSURANCE FUND Policy Number: 9053224 _ 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' 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 tb 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 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: Signature (Applicant or Agent): Date: 9/21/2017 Application Number: BCOM2016-0018 Owner: Property Address: 47875 CALEO BAY STE 101 CALEO BAY APN: 643200038 P 0 BOX 13230 Application Description: PHAN / CALEO.BAY ORTHODONTICS , PALM DESERT, CA 92253 Property Zoning: Application Valuation: $125,000.00 Applicant: Contractor: GABRIEL LUJON BRADLEY -JORDAN CONSTRUCTION COMPANY INC 36947 COOK ST STE 104 PO BOX 3428 PALM DESERT, CA 92253 FULLERTON, CA 92834 ' (714)356-1203 Llc. No.: 669244 Detail: 2363 SF INTERIOR TENANT IMPROVEMENT FOR "CALEO bAY ORTHODONTICS" IN SUITE 101. TYPE VB W. FIRE SPRINKLER, "B" OCCUPANCY, 24 OCCUPANT LOAD. 2013 CODES. DESCRIPTION ACCOUNT QTY AMOUNT ART IN PUBLIC PLACES•- COMMERCIAL REMOD 270-0000-43201 0 $125.00 Total Paid for ART IN PUBLIC PLACES - AIPP: $125.00 DESCRIPTION ACCOUNT QTY AMOUNT HOURLY CHARGE - CITY BUILDING STAFF 101-0000-42600 1 $145.00 Total Paid for BLDG CITY STAFF - PER HOUR: $145.00 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $5.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $5.00 DESCRIPTION ACCOUNT. QTY AMOUNT DEVICES, ADDITIONAL 101-0000-42403 0 $413.82 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, ADDITIONAL PC 101-0000-42600 0 $102.60 DESCRIPTION ACCOUNT QTY AMOUNT DEVICES, FIRST 20 101-0000-42403 0 $24.17 DESCRIPTION. ACCOUNT QTY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $24.17 Total Paid for ELECTRICAL: $564.76 DESCRIPTION ACCOUNT QTY AMOUNT OTHER MECHANICAL EQUIPMENT 101-0000-42402 0 $36.26 DESCRIPTION ACCOUNT QTY AMOUNT OTHER MECHANICAL EQUIPMENT.PC 101-0000-42600 0 $36.26 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $12.09 Total Paid for MECHANICAL: $84.61 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP 101-0000-42401 0 $36.27 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $36.27 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT PC 101-0000-42600 0 $7.25 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 DESCRIPTION ACCOUNT QTY AMOUNT WATER SYSTEM INST/ALT/REP PC 101-0000-42600 0 $12.09 Total Paid for PLUMBING FEES: $116.06 DESCRIPTION ACCOUNT . QTY AMOUNT REMODEL,.EA ADDITIONAL 500 SF 101-0000-42400 0 $108.75