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