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BCOM2017-005378-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 `��r�FlwQ�rw DESIGN & DEVELOPMENT DEPARTMENT .. BUILDING PERMIT Permit Type/Subtype: BUILDING COMMERCIAL/REMODEL Application Number: f5CQIVI2017--005_ Property Address: 78742 HIGHWAY 111 APN: 643220016 Application Description: POKEHANA / ADD 2 PATIO HEATERS Property Zoning: Application Valuation: $5,500.00 r Applicant: MIRAGE DEVELOPERS INC L`l 2011 P0BOX942 ir THOUSAND PALMS, CA 92276 i�((�aFLAQ��NTA 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.: 884711 Dater Z1 7 Cont`a tor: rr. 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 ) 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.&F.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 Na Lender's Address: VOICE (760)777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 12/21/2017 Owner: JAY LEE 78742 HIGHWAY 111 STE A LA QUINTA, CA 92253 Contractor: MIRAGE DEVELOPERS INC P 0 BOX 942 THOUSAND PALMS, CA 92276 (760)864-9448 Llc. No.: 884711 WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one )f the following declarations: _ I have and will maintain a certifica�e of.consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the y/gllc for which this permit is issued. Zhave and will maintain workers' compensation insurance, as required by Secti n 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: EVEREST NATIONAL INSURANCE COMPANY Policy Number: 76000154571 _ I certify that in the performance ofthe work for which this permit is issued, I shall not employ any person in any manner sc 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 4700 of the Labor Code, I shall forthwith comply with those rrprovisions. Da�e� Z Zl l A WARNING: FAILURE TO SECURE WORKERS' CCMPENSATION 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 FO.R IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNCWLEDGEMENT ' 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 -he applicant, each agrees to, and shall defend, indemnify and hold harmless the City cf La Quinta, its officers, agents, and employees for any act or omission related to tF a 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. 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. Dater Z j Sign�atLuet(Applicant or Agent): a` Date: .12/21/2017 Application Number: BCOM2017-0053 Owner: Property Address: 78742 HIGHWAY 111 JAY LEE APN: 643220016 e 78742 HIGHWAY 111 STE A Application Description: POKEHANA /ADD 2 PATIO HEATERS LA QUINTA, CN 92253• Property Zoning: Application Valuation: $5,500.00 . Applicant: Contractor: MIRAGE DEVELOPERS INC MIRAGEDEVE-OPERSINC P O BOX 942 P 0 BOX 942 THOUSAND PALMS, CA 92276 THOUSAND PALMS, CA 92276 (760)864-9448 Llc. No.: 884771 Detail: FINANCIAL INFORMATION DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0. $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT APPLIANCES, NON -RES 101-0000-42403 I 0 $52.02 DESCRIPTION ACCOUNT QTY AMOUNT APPLIANCES, NON -RES PC 101-0000-42600 0 $52.02 Total Paid for ELECTRICAL: $104.04 DESCRIPTION ACCOUNT QTY AMOUNT WALL HEATER 101-0000-42402 .0 $52.02 DESCRIPTION ACCOUNT QTY AMOUNT WALL HEATER PC 101-0000-42600 0 $26.00 Total Paid for MECHANICAL: $78:02 DESCRIPTION ACCOUNT QTY AMOUNT PERMIT ISSUANCE 101-0000=42404 0 $98.83 -Total Paid for PERMIT ISSUANCE: $98.83 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $13.00 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600. 0 $26.01 Total Paid for PLUMBIMG FEES: $39.01 DESCRIPTION ACCOUNT QTY AMOUNT, RECORDS MANAGEMENT FEE 101-0000-42416 0 $10.00 Total Paid for RECORDS MANAGEMENT FEE: $10.00 DESCRIPTION ACCOUNT QTY AMOUNT. TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT.FEE: .$S.00 J: sirr. # City, Of - La Quin to Building 8r Safety Division P.O. Box 1504,"78-495 Calle Tampico La.Quinta, CA 92253 -:(760) 777-7012 `I �00W uilding Permit Application' and Tracking Sheet Permit # Project Address:,? Z, �` :. A P. Number. l Z l [77dd LegalDescription: City, ST, Zip: L C ZZ Contractor. �� ` �s L Y� Telephone: 3' Project Description: Address: .T City, ST, Zip: Q 2 % o Telephone: 7- -Q� State Lia # : City Lie'. # s Arch, EW., Designer. e-T_t6Graf U� Address: City, ST, Zip: Telephone: Construction Type:. Occupancy: Project type (circle one): New Add'n Alter Repair Demo State Lic. #: " : ' Name of Contact Person:V�Jk l C, - e,(- Sq. Ft.: # Stories: #Units: Telephone # of Contact Person: p- �L- 2FJ -L Estimated Value of Proj i �UL7 APPLICANT: DO NOT WRITE BELOW THIS UNE N Submittal Req'd -Reed TRACKING PERMIT FEES - Plan Sets Pian Check submitted Item Amount Strgdural Calcs. Reviewed, ready for corrections Plan Check Deposit. . Truss Calcs. Called Contact Person Pian Check Balance Title 24 Cale& Pians picked up Construction Flood plain plan Plans resubmitted.'. Mechanical Giadlog plan 2u Review, ready for correctionsfissue Electrical Subcontactor List I Called Contact Person Plumbing Grant Deed Plans picked up H.O.A. Approval Plans resubmitted Grading IN HOUSE:- 34 Review; ready for correcdonslissae Developer Impact Fee Planning Approval. Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees