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BCOM2017-002378-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BCOM2017-0023 Property Address: 78115 CALLE ESTADO STE 105 APN: 770152017 Application Description: MFH PIERCE GROUP /.1,416SF TEN1PIMPRMENT H � I Property Zoning: I Application Valuation: $10,000.00 I SII II Applicant: SOUTH WEST CONCEPTS, INC. 78115 CALLE ESTADO, SUITE 105 LA QUINTA, CA 92253 AUG 17 2017 CIT 0FLAQUINTA COMMUNITY DEVELOPMENT DEPARTMENT 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: License No.: 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 violatiori of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ._Il),,;s owner of the property, or my employees with wages as their sole ompensation, 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 Ashe did not build or improve for the purpose of sale.). -6, as owner of the property, am exclusively contr cting with licensed contractors I trust the project. (Sec. 7044, Business and Pr sions Code: The Contractors' State License Law does not apply to an owner of. pro e y who builds or improves thereon, and who contracts for the projects with a c nt actor(s) licensed pursuant to ntractors' State License Law.). am exempt under Sec. B.&P.C. fr reason •Full M 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 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 8/17/2017 Owner: MFH PIERCE GRCUP 78090 CALLE ESTaDO LA QUINTA, CA 93253 Contractor: OWNER / BUILDER Llc. No.: 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 370C 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 forkjecttothe ermit is issued, shall not employ any person in any manner so as to becomworkers' compensation laws of California, and agree that, if I shouldject to the workers' compensation provisions of Section 3'00 of theshall forthwith comply with those provisions. 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 FOWIN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application. is hereby made to the Building Official for 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, g� cessation of work for 180 days will subject permit to cancellation. /' I certify that I have read this application and stare that the ab • f tion is correct. I agree to comply with all city and county ordin.rnces and se law ting to building construction, and hereby authorize representat_ves of this to a the above-mentioned pr�erty for inspection purposes. 'y _ Signa�plicantor Agent): 1 Date: 8/17/2017 Application Number: BCOM2017-0023 Owner: Property Address: 78115 CALLE ESTADO STE 105 MFH PIERCE GRC UP APN: 770152017 78090 CALLE ESTADO Application Description: MFH PIERCE GROUP/ 1,416SF TENANT IMPROVEMENT LA QUINTA, CA 92253 Property Zoning: Application Valuation: $10,000.00 Applicant: Contractor. SOUTH WEST CONCEPTS, INC. OWNER / BUILDER 78115 CALLE ESTADO; SUITE 105 LA QUINTA,-CA 92.253 --------------- --------------------------------------------------------------------- Llc. No.: Detail: TENANT IMPROVEMENT FOR SOUTHWEST CONCEPTS" OFFICES SUITES 105, 106 &'107,1,416 SQ.FT. NEW SING W/ TANKLESS WATER HEATER, TWO NON BEARING INT. PARTITIONS. EXISTING LIGHTING. 2016 CODES. 1 l ,• l. FINANCIAL DESCRIPTION ACCOUNT QTY AMOUNT FIRE COMMERCIAL TI 101-0000-22811 1 $614.00 Total Paid for FIRE COMMERCIAL TI: $614.00 DESCRIPTION ACCOUNT QTY AMOUNT WATER HEATER/VENT 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT . QTY AMOUNT WATER HEATER/VENT PC 10.1-0000-42600 0 $7.60 Total Paid for PLUMBING FEES: $20.27 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, EA ADDITIONAL 500 SF 101-0000-42400 0 $68.40 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, EA ADDITIONAL 500 SF PC 101-0000-42600 0 $54.72 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, FIRST 100 SF 101-0000-42400 0 $51.68 DESCRIPTION ACCOUNT QTY AMOUNT REMODEL, FIRST 500 SF PC 101-0000-42600' 0 $141.36 Total Paid for REMODEL: $316.16 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE:' . $5.00 Bin # City of La Qurnta Building 8r Safety Division Permit # 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 [QMuilding Permit Application and Tracking Sheet Project Address: -7S It [pj Owner's Name: M I CC r EVE A. P. Number: 0 - ` — Q f (2 + Address: [� �� cn I — Stu d c) Legal Description: City, ST, Zip: L-0— }v' 10• Contractor: Telephone: Address: Project Description: City, ST, Zip: Telephone: S''x �r� [ �`•� �.� State Lie. # : City Lie- #; lq -� �''• �G Arch., Engr., Designer: L Address: ` 7. f C • fvc Q City, ST, Zip: Telephone: , 6 j ;_- Construction Type: A. Occupancy: AJL __- _•;! State Lie. Project type circle one New Add'n (�it Repair Demo Name of Contact Person: S Sq. FL: 11- ? # Stories: #Units: Telephone # of Contact Person:EW -� Estimated Value of Project: �' ] i APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cales. Reviewed, ready for 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 Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 3 a Review, ready for correctionstissue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees Tityl 4 4aabrw P.O. Box 1504 LA QUINTA, CALIFORNIA 92247-1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT PROPERTY OWNER'S PACKAGE (760)777-7012 FAX (760) 777-7011 Disclosures & Forms for Owner -Builders Applying for Construction Permits IMPORTANTI NOTICE TO PROPERTY OWNER Dear Property Owner; An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified at We are providing you with an Owmer-Builder Acknowledgment and Information Verification Form to make you aware of your responsibilitics and possible risk you may incur by having this permit issued in your name as the Owner -Builder. We will not issue a building peratit until you have tread, initialed your understanding of each provision, signed, and returned this farm .to us at our official address indicated. An agent of the owner cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority. OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION DIRECTIONS: Read and initial each statement below to signifyyou understand or verify this information. 1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -Builder" building permit that erroneously implies that the property owner is providing his or her own labor and material personally. 1, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries sustained by an unlicensed person and his or her employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of the limits of my insurance coverage for injuries to workers on my property. 2. I understand building permits are not required to be signed by property owners unless they are responsible for the construction and are not hiring a licensed Contractor to assume this responsibility. 11 understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my own. 4. I understand Contractors are required by law to be licensed and bonded in California and to, list their license numbers on permits and contracts. 5. I understand if I employ or otherwise engage any persons, other than California licensed Contractors, and the total value of my construction is at least five hundred dollars ($500), including labor and materials, I maybe considered an "employer" under state and federal Iaw. 6. I understand if I am considered an "erployer" under state and federal law, I must register with the state and federal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject me to serious financial risk. 7. I understand under California Contractors' State License Law, an Owner -Builder who builds single-family residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed under contract with a licensed general building Contractor. 8. I understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction defects in the workmanship or materials. 9. I understand I may obtain more information regarding my obligations as an "employer" from the Internal Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments, and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1- 800-321-CSLB (2752) or www.cslb.ca.gov for more information about licensed contractors. 10. I am aware of and consent to an Owner -Builder building permit applied for in my name, and understand that I am the party legally: and - financially responsible for proposed construction activity at the following address: 11. I agree that, as the party legally and financially responsible for this proposed construction activity, I will abide by all applicable laws and requirements that govern Owner -Builders as.well as employers. 12. I agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public. If you contract with someone who does not have a license, the Contractors' State License Board may be unable to assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held liable for damages. If you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage. A Before a building permit can be issued, th' o ust be completed and signed by the property owner and returned to the agency responsible for issuing the pe mit. te. copy of the property owner's driver's license, form notarization, or other verification acceptable to the age 3 is uir to be presented when the permit is issued to verify the property owner's signature. Signature of property owner Date: J.' 1 2 Note: The following Authorization Form is required to be completed by the property owner only when designating an agent of the property owner to apply for a construction permit for the Owner -Builder. AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner -Builder Permit for my project. Scope of Construction Project (or Description of Work): } Project Location or Address. 45 0 � I '(J•� •I e�/ . I Name of Authorized Agent: Tel No 760 Address of Authorized Agent: AZ-V-/ICI ^`7 ONDC/Ar.- I declare under penalty of perjury that I am the pr owner for the address listed above and I personally filled out the above information and certify its accuracy. Note: A cop the owner's driver's license, form notarization, or other verification acceptable to the agency is required to be pr d when the permit is issued to verify the property owners signature. Property Owner's Signature: Date: 8' '■ Building Permit Ntmtber. FB=C0M2(M7-0M3 Project Description: Improvement Exempt 10 (Materials may► contain hazardous wastes and ate not subject to recycling pmvlslons) Constructm Construction Debris Manageent Plan Plan Submittal Datel 8118NO17 Job Site Addrew Owner's Name Number, Street, or PO Boa City, State, Postal Code Owna s Phone Numbe, Owners E-Mail Address Project Managers Name Project Managees Phone Number Project Manager's E-mail Address Bullder I Conrracor Number, Street or PO Box City, State. Postal Code PmJevct Square Footage City Approval By Date of City Approval Mateftiq To Be Discarded: 78-115 Calls Estado, Ste 105 La QuInta, CA 92253 southwest Concepts Inc 78-115 Calle Estado, Ste 105 Le Quints, CA 92253 780155"707 stencepts.com Stephen R. Mato 780-333.2179 stsvwr��pts rim Stephen R. Mato 78-115 Cape Estado, Ste 105 IA Quints, CA 97253 Approx 433 square feet Renadc Gouklleck-Moaurrtea We Product Tars Trash 0.91 Not recyclable Product Tons Asphalt 0.00 Rscyolable Masonry (broken) 0.00 Brick/Block O.FO Recyclable Plater 0.00 Cardboard 0.00 Recyclable Scrap Metal 0,20 Commingled 0.00 Reelable Tile (floor) 0.00 Concrete 125 Reayatable Tile (roof) 0.00 Drywall 0.25 Reoy-dbbre Wood 0.00 Donated 1 Reuse* 0.00 Recyclable Landscape Debris F 0.00 *Describe Items I ls: Rawcle Trash Projected Dhrersion: 1.7 0.9 85.139ir 1 urderstsnd it h the properly owner's responslblltty to submit copiss of weight tip or rvc VW to the District FnvWGnmental Cocrdinatoran # mxe hauls occur. I hereby cartlfy that completion, Implementation and adherence Of the Debris Management Plan (DMP) for the alcove named pr01ect sha11 guarantee that at teas# 66% of the jobsits waste is divartad from land'Ung. The remaining material will be recycled or reused. I will divert, for racycring or reuse. remaining materials generated from the first day of the project through the completion of the project In acoordance with this plan. This DMP Is issued In time name of the property owner(s) and sha11 remain their property throughout the conehuotion andlor demolition project. A Contractor serving as agent of time owner may obtein a DMP for the owner. However, the DMP la still leaved In tha name of time property owners) and tha owner retains legal rasponslbiiftyfor ensuring that the provialans of the OMP are adhered to. The property owner(s) and general contractor shell be kept Informed of the diversion progress through bimonthly reports. if self -hauling, all refuse material from this project site must be taken to an approved recycle or trars€ar Owner I Developer I Project Manager 13upaintendanl �-7 J Or CITY OF LA QUANTA SUB -CONTRACTOR. LIST � JOB ADDRESS `J11 l __ _ PERMIT NUMBER OWNER �BUILDEI This form shall he posted on the '6)� Wit)3 the €3uildin - it_1s ectia Card at all times in a cons(�icuo«s })lPce. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by. the Building Division prior to commencement of work- Failure to comply will result in a stoppage of work and/or the voidance of buildilzg permit. For each applicable trade, all information requested below must be completed by applicant, "On File" is not an acceptable response. ... ...... ..:: .. :.. .. ,:.::..;:.. •.::::.::.:....:::: 77 .. ... _, >.:::::.. .:.... zltrnsa in�i lrisitraiSGc°�°=`::°�:::::.•...:••�::;: ;=. �.:;.;Cv,�titracton.:.::...' :::.;. Stoic.:C.pntractnr-s,-Lic�hsr:'=.., ark�rs:Cpl,..l... t W Company Name Classification License Numher Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date (e.g. A, B, C-8) (xxxxxx) (xx/xx/xx) (e.g. state Fund, CalComp) (Format Varies) (xx/xx/xx) (xxxx) (xxlxxlxx) FFIR'CIIVNC�iIC:{t.-7.21 :. Co14cRrTF'(C=8) Q 1 FRAMING (c= .). — : � S$ ��Di '��• � 9��14� �' `�� 4% D��d �' II STr MASO.Nflly (C-29) :. 'PLUMBING (C-36) €:llC'FI,.PLIISTEIi.{C:.3a) r ' q 2 q _r�,- a�v,yn� [c:<�) �� ." J lQ�G97 Y�.- .�/ W 773L!, HVAC` [C-M:. ELECTRICAL (C T U) SHEET METAL (C-43). GLAZING [C--'171 : INSULAT)ON. (C 2) SEWAGE DISI': (C-42) ..- ddll�� _ _ PnlEurlrl C�-33) �Y''� �4 �9 �I -- — 3•f �l - , — • ME CE[J/\M1C Tll.f'!(C 4� r q..a G 1p 8�9L 610 67 F164 5S CABINETS FENCING (C-331 -- - LAN []SCAPING. (C-27) POOL 74 L11 WME f9