BCOM2016-0051I .j
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Twit 4 1wQuilkrw
DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS(760)777-7153
Date: 1/17/2017
Application Number:
BCOM2016-0051
Owner:
Property Address:
78962 HIGHWAY 111
MCD ONALDS COR?
m
APN:
643080008
3800 KILROY AIRPOR1/Y #2
Application Description:
MC 60NALDS / (1)GATEWAY (2)CANOPYS AND (1) PRESALE BOARD
LONG BEACH, CA 9082
Property Zoning:
z
Application Valuation:
$12,000.00
C-)
M O
Z
Applicant:
Contractor:
r__
DESIGNUA -TOM LE
C C K BUILDERS INC
zqz
v
12832 VALLEY VIEW #C
625 WEST KATELLA Atmel&
#2 ry
GARDEN GROVE, CA 92845
ORANGE, CA 92867
� :.
o
D
(714)538-8200
M
X
Llc. No.: 855822
M
M
z
---------------------------------------------------------------------------
-�
------------------
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 i4 full force and effect.
License Class: B' License No.: 855822
e.—'[ Contractor",
OWNER -BUIL DEC RATION
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 isnot 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 Na
Lender's Address:
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one ofthe 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.
JI 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: INSURANCE COMPANY OF THE WEST Policy Number: WSD5021797
I certify that in the performance of (he work for which this permit is issued, I
shall not employ any person in any manner so es 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 3 700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: t 17-/7 Applicant:
WARNING: FAILURE TO SECURE WORKERS PE ATION 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 FOF 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 thi! application.
1. Each person upon whose behalf this appli•:ation 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 owns, 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 ssuance 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 ordi -iances 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:' �,� �1 —� Signature (Applicant orAgent .
Detail:
Date: 1/17/2017
Application Number:
BCOM2016-0051
Owner:
Property Address:
78962 HIGHWAY 111
MCDONALDS CORD
APN:
643080008
3800 KILROY AIRPORT WY #200
Application Description: _
MC DONALDS / (1)GATEWAY (2)CANOPYS AND (1) PRESALE BOARD
LONG BEACH, CA 90806
Property Zoning:
Application. Valuation:
$12,000.00
Applicant: `
Contractor:
DESIGNUA-TOM LE
C C K BUILDERS INC,
12832 VALLEY VIEW #C
625 WEST KATELL%AVENUE #2
GARDEN GROVE, CA 92845
ORANGE, CA 92867
(714)538-8200
55822
Llc. No.: 855822-
Detail: ORDER CANOPY 2 EA, AND DRIVE THRU BAR, INCLUDING ELEC. TO BE CONSTRUCTED PER 2013 CBC CODES
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT
•D.TY AMOUNT
HOURLY CHARGE - YES ADMINISTRATIVE STAFF
101-0000-42600
01.25 $10.00
DESCRIPTION
ACCOUNT
QTY AMOUNT
HOURLY CHARGE - YES STRUCTURAL PLAN REVIEW ENGINEER
101-0000-42600
2 $190.00
Total Paid for BLDG CITY STAFF - PER HOUR: $200.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20
101-0000-42403
0
$25.33
DESCRIPTION
ACCOUNT
QTY
AMOUNT
DEVICES, FIRST 20 PC
101-0000-426000
$25.33
Total Paid for ELECTRICAL: $50.66
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PATIO COVER, DESIGNED
101-0000-42404
0
$101.84
DESCRIPTION
ACCOUNT.
QTY
AMOUNT
PATIO COVER, DESIGNED PC
101-0000-42600
0
$100.32
Total Paid for PATIO COVER / COVERED PORCH / LATTICE: $202.16
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
78401--_1414KwAY
Bin #
✓�'��t_ �wJ�
Project Address: 76. C e -
:.City of b Quin t
Building 8F Safety Division `
78-495 Calle Tampico
La Qui nta, CA 92253 -_(760) 777-701,2 Y
Building"Permit Applicatidn and Tracking'Sheet -
/ // �7 owner's Name: e y%dt (S C�/�
`
A. P. Number:
Address: �$�0 a r _
Legal Description:
"
City,' ST, Zip:
r Contractor:.
D _ F
T 1 h nc:
ee o
P
Address:
Project Description:
City, ST, Zip:
62
T leP Ito . ne-
State Lic. # :
CityLic. #.: .".
.Arch., Engr., Designer: `
Address:
City, ST, Zip:
li
Telephone
one:
,
L#.
t ic.
State a 7 � 0
Q
Construction Type: O ccu c Y�
Z
Project type (circle one)• .New Add'n Alter Repair• Demo
0
Name of Contact Person: &
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: 4 ,
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rcc'd
TRACKING.
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount.
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cates.
Called Contact Person
Plan Check Balance.
Tit!e 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2nd Review, ready for corrections/issue
Electrical
SubcontactorList
Called ContactPcrson ...;
Plumbing
Grant Deed
Plans picked up
S.M.I.
M.O.A. Approval
.
flans resubmitted
Grading
IN IiOUSE:-
3'9 Review, ready for, corrections/issue
Developer. Impact Fee
Planning Approval
Called Contact Pe son
A.I•P.P.
I'ub. Wks. Appr
�
Date of permit issue. i
School Fees,
,
Total Permit Fees -