BCOM2017-003178-495 CALLE TAMPICO
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LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: BUILDING COMMERCIAL/REMODEL
Application Number:
BCOM2017-0031
Property Address:
78441 HIGHWAY 111
APN:
"604050059
Application Description:
EUROPEAN WAX CENTER / TI
Property Zoning:
,
Application Valuation:
$65,000.00
Applicant: _4�7�---
RICH KENDZIERSKI En
0
SEP 19 2017
CITY OF LA QUINTA-J
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 70001 of Division 3 of the Business and Professions Code, and
my License is in full force and effect.
License Class: B License No.: 723432
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 Address:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/19/2017
Owner:
HARSCH INV REALTY
1121 SALMON ST 4TH FL
PORTLAND, CR 92253
Contractor:
C C & M INCCIRPORATED
23905 CLINTON KEITH RD 114-200
WILDOMAR, CA 92595
(951)600-0783
Llc. No.: 7234-32
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have and will maintain a certifiote of consent to self -insure for workers'
compensation, as provided for by Section 3-00 of the Labor Code, for the performance
of trk for which this permit is issued.
IN! I have and will maintain workers°,compensation insurance, as required by
Section 3700 of the Labor Code, for the perbrmance of the work for which this permit is
issued. My workers' compensation insuraniie carrier and policy number are:
Carrier: STATE COMPENSATION INSURANCE FUND Policy Number: 9023312
_ I certify that in the performance cf the work for which this permit is issued, I
shall not employ any person in any manner :o as to become subject to the workers'
compensation laws of California', and agree :hat, if I should become subject to the
workers' compensation provisions of Sectio■ 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 1 — /9 —/ % —Applicant:
L___
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,)00). 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 Citr of La Quinta, its officers, agents, and
employees for any act or omission related torthe 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 :tate that the above information is correct.
I agree to comply with all city and county ord nances 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: ���� �/ 7 CSignature(Applicantor�):
Date: 9/19/2017
Application Number: BCOM2017-0031
Owner:
Property Address: 78441 HIGHWAY'111
HARSCH INV REALTY
APN: 604050059
1121 SALM014 ST 4TH FL
Application Description: EUROPEAN WAX CENTER / TI
PORTLAND, OR 92253
Property Zoning:
Application.Valuation: $65,000.00
Applicant:
Contractor:
RICH KENDZIERSKI
C C & M INCCRPORATED
23905 CLINTON KEITH RD 114-200
WILDOMAR, CA 92595
(951)600-078.3
--------------------------------------------------------------------------------------------
Llc. No.: 723462
Detail: 1,480 SQ.FT. INTERIOR TENANT IMPROVEMENT FOR THE "EUROPEAN WAX CENTER". "B"
OCCUPANCY, 33 OCCUPANT LOAD. PERMIT INCLUDES
SINGLE USER TOILET ROOM, LIGHTING & SWITCHING CONTROLS, HVAC DUCTS, PLUMBING, INTERIOR
PARTITIONS 2016 CODES. BUSINESS SIGNAGE
REQUIRES A SEPARATE PERMIT.
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT QTY AMOUNT
BSAS SB1473 FEE 101-0000-20306 0 $3.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $3.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCES, NON -RES
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCES, NON -RES PC
101-0000-42600
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT•
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-42600
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES/FIXTURES, ADDITIONAL
101-0000-42403
0
$151.80
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES/FIXTURES, ADDITIONAL PC
101-0000-42600
0
$37.80
Total Paid for ELEIZTRICAL: $290.92
DESCRIPTION
ACCOUNT
QTY'
AMOUNT
OTHER MECHANICAL EQUIPMENT
101-0000-42402
0
$190.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
OTHER MECHANICAL EQUIPMENT PC
.101-0000-42600
0
$190.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
VENT FAN
101-0000-42402
0
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
VENT FAN PC
101-0000-42600
0
$5.07
Total Paid for MECFANICAL: $397.74
DESCRIPTION
ACCOUNT I
QTY
AMOUNT
FIXTURE/TRAP
101-0000-42401
0
$25.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIXTUREITRAP PC
101-0000-42600
0
$25.34
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT
101-0000-42401
0-
$12.67
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER HEATER/VENT PC
101-0000-42600
0
$7.60
DESCRIPTION
ACCOUNT
QTY
AMOUNT
WATER SYSTEM INST/ALT/REP
101-0000-42401 0
$12.67
DESCRIPTION
ACCOUNT QTY
AMOUNT
WATER SYSTEM INST/ALT/REP PC
101-0000-42600 0
$12.67 .
Total Paid for PLUMBING FEES: $96.29
DESCRIPTION
ACCOUNT } QTY
AMOUNT
0
CC&M Incorporated .
23905 Clinton Keith Road, #114-200
Wildomar, Ca. 92595
SEPTEMBER 19, 2017
City of La Quinta
Planning/Building Department
Re-EWC-La Quinta #2
Please accept this as authorization for: RICH KENDZIERSKI AND/OR DANIELLE FINK, Agents for -CC&M,
to act as a representative for CC&M Incorporated, to either release the plans, and/or issue the Building
Permit associated with the project known as: EUROPEAN WAX CENTER -LA QUINTA. This proposed
project is located at 78-441 HIGHWAY 111, LA QUINTA, CA. 92253. On behalf of CC&M Incorporated,
please find the necessary documents, to pull the building permit.
Our Contractors License #723432
Copy of Matt's Driver License
A copy of our current Contractors Bond
A copy of our Insurance Coverage for Auto, General Liability/Workers Comp and Umbrella
Policies.
if you have'any questions, or need any additional information, please feel free to contact me, on my cell
° at: 951-600-0783.
Sincerely,
Karen annan
CC&M Inc..
Secretary/Treasurer
ADDRESS 79) — Mr l
PR JECT DESCRIPTION lel
i�z6127-7
New Construction / T.,T
CONDITIONED/AC (SF) ! �
GARAGE/UNCOND (SF)
PATIO/COVERED (SF)..
FIRE SPRINKLER (SF) �f
CODE EDITION
❑
CONSTRUCTION TYPE
❑
q� GOOD
YES / NO
NUMBER OF FLOORS
gUMBER OF BEDROOMS
NUMBER OF UNITS
OCCUPANTLOAD
OCCUPANCY
MSHCP (DU/ACRE)
(DWELLING UNITS PER ACRE, EX: 43,560SF77,0DOSF
Lot = 6,22OU/ACRE)
Remodel/Addition
REMODEL AREA (SF)
ADDITION AREA (SF)
AWNING/CANOPY (EA)
BALCONY ADDITION (EA):i
FIREPLACE (EA)
PARTITION (EA)
STUCCO APPLICATION (SF)
DOOR/WINDOW - REP (EA)
DOOR/WINDOW - NEW (EE1)
CARPORT (EA).
VALUATION
(AS SHOWN ON BUILDING APPLICATION)
Grading
TRACT
❑
CUSTOM HOME <=71<SF
❑
CUSTOM HOME >7KSF .
❑
APPLICATION
DATE
Mechanical Units
FURNACE
HEATER
APPLIANCE (ALT/ADD)
COMPRESSOR
AIR HANDLER
EVAP COOLER
VENT FAN
EXHAUST HOOD
MISC MECHANICAL
Electrical Units_
NEW ELECTRICAL
and/or
RECEP/SWITCH/LIGHT 20,
plus
APPLIANCE - RES
APPLIANCE - NONRES
POWER APPARATUS
SIGNS
SERVICE
TEMPORARY SERVICE
MISC ELECTRICAL
LIGHT POLES
PV SYSTEM - ARRAY
PV SYSTEM - MISC EQ
Plumbing Units
FIXTURE/TRAP
SEWER
SEPTIC
ROOF DRAIN
WATER HEATER
GREASE INTERCEPTOR
WATER PIPING
BACKFLOW
GAS OUTLETS
REVISED: 7/15/2015 RESIDENTIAL
~-
�^.
\ `^
\
Unit Counts Qty
TOILETS
BIDET/URINAL
. �
SHOWERS '
BATHTUBS
SINKS
BAR � �r^
,88Q `
OVEN
RANGE'
[OOKTOP =_ '
DRINKING FOUNTAIN,
'
`
WASHER
�0RYER
WATER HEATER —
,
ROOF DRAINS �
FLOOR DRAINS �
KITCHEN SINK
VEGGIE SINK
`
LAUNDRY SINK �
FIREPLACE
REVISED: 7/15/2015 RESIDENTIAL
"
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Permit Number: BCOM2017-0031
Bin#
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City of La Quinta
Building & Safety Division
787495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
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Stat Lic. 2
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Arch, Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Construction Type:
Occupancy:.
State Lic. #:
Proj. Type
New
Add'n
Alter
Repair
Demo
Name of Contact: �t I vee 1 �i�
SgFt:
#Stories
# Units:
phone of Contact: 7� O Cd`
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APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req 'd
Rec'd
TRACKING
PERMI— FEES
Plan Sets
Plan Check Submitted
Item
Amount
Structural Calcs
Reviewed, ready for corrections
Plan Chsck Deposit:
Truss Calcs
Called Contact Person
Plan Check Balance:
Title 24 Calcs
Plans Picked Up
Construction:
Flood Plain Plan
Plans Resubmitted
Mechan cal:
Grading Plan
2nd Rev, Ready for corrections /
Electrical:
Subcontractor List
Called Contact Person
Plumbing:
Grant Deed
Plans Picked Up
S.M.I.
HOA Approval
Plans Resubmitted
Grading
IN-HOUSE
3rd Rev, Ready for corrections /
Develop -.r Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Apps
Date of permit issue
School Fees
Total Permit Fees