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BCOM2016-0069�a 78-495 CALLE TAMPICO D �iNILICl/ LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BCOM2016-0069 Property Address: 46080 JEFFERSON ST ST APN: 600070012 Application Description: CONTOUR DERMATOLOGY/ 5,544SF OFFICE/VB/B-OCC/55-OL/SPRINK Property Zoning: Application Valuation: $440,409.90 Applicant: PREST VUKSIC ARCHITECTS INC: 44530 SAN PABLO STE 200 PALM DESERT, CA 92260 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 A License No.: 693077 Dater ZZ7 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 ) 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 ) 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 Add VOICE (760) 777-7125 FAX (760) 777-7011: INSPECTIONS (760) 777-7153 Owner: E1 LA QUINTA LLC 42600 MIRAGE RD RANCHO MIRAGE, CA 92270 Contractor: ORR BUILDERS 39-301 BADGER STREET STE .PALM Df SERT, CA 92211 (760)360-6632 Llc. No.: 693077 Date: 5/22/2017✓ 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 w k for which this permit is issued. 't ave and will maintain workers' compensation insurance, as required by ch, on 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: GRANITE STATE INSURANCE COMPANY Polity Number: WC065258934 _ 1 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 3.700 of the. Labor Code, I shall forthwith comply with those provisions. Date: Applicant: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALLSUBJECT 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: ��Signature (Applicant or" ae��,z Dater 5/22/2011 Application Number: BCOM2016-0069 Owner: ' Property. -Address:• ••.,%:';,.,-46080 JEFFERSOA13hST EJ LA QUINTA LLC APN: 600070012 42600 MIRAGE RD Application Description: CONTOUR DERMATOLOGY / 5,544SF OFFICE/VB/B-OCC/55-OL/SPRINK RANCHO MIRAGE, CA 92270 Property Zoning: Application Valuation: $440,409.90 Applicant: Contractor: PREST VUKSIC ARCHITECTS INC. ORR BUILDERS 44530 SAN PABLO STE 200 39-301 BADGER STREET STE 300 PALM DESERT, CA 92260 PALM DESERT, CA 92211 (760)360-6632 ------=------------------------------------------------------------------ Llc. No.: 693077 ------------------ - Detail: 5,544SF OFFICE BUILDING/VB/B-OCC/55-OL/FULLY SPRINKLED [CONTOUR DERMATOLOGY] THIS PERMIT DOES NOT INCLUDE BLOCK WALLS, BUILDING SIGNAGE, SITE LIGHTING, CARPORTS, OR TRASH ENCLOSURES. CVMSHCP DOES NOT APPLY BASED ON EXISTING LAND USE; TUMF ASSESSED FOR ENTIRE BUILDING WITHOUT CREDIT DUE TO RECREATIONAL AREA (GOLF COURSE) STILL REMAINING. 2016 CALIFORNIA BUILDING CODES. ��FINANCIAL INFORmAT.IM DESCRIPTION ACCOUNT QTY AMOUNT ART IN PUBLIC PLACES - COMMERCIAL 270-0000-43201 0 $2,202.05 Total Paid for ART IN PUBLIC PLACES - AIPP:. $2,202.05 DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101-0000-20306 0 $18.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $18.00 DESCRIPTION ACCOUNT QTY AMOUNT DIF - CIVIC CENTER 252-0000-43200 0 $2,067.91 DESCRIPTION ACCOUNT QTY AMOUNT DIF - FIRE PROTECTION 257-0000-43200 0 $948.02 DESCRIPTION ACCOUNT- QTY AMOUNT DIF - STREET MAINTENANCE 255-0000-43200 0 $1,053.36 DESCRIPTION ACCOUNT QTY AMOUNT DIF -TRANSPORTATION 250-0000-43200 0 $25,751.88 Total Paid for DIF -OFFICE/HOSPITAL: $29,821.17 DESCRIPTION ACCOUNT QTY AMOUNT TEMP POWER SERVICE 101-0000-42403 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT TEMP POWER SERVICE PC 101-0000-42600 0 $17.73 Total Paid for ELECTRICAL: $43.06 DESCRIPTION ACCOUNT QTY AMOUNT NON-RESIDENTIAL, EA ADDITION 2,000SF 101-0000-42403 0 $114.00 DESCRIPTION ACCOUNT QTY AMOUNT NON-RESIDENTIAL,.EA ADDITION 2,000SF, PC 101-0000-42600 0 $30.39 DESCRIPTION ACCOUNT QTY AMOUNT NON-RESIDENTIAL, FIRST 2,000SF 101-0000-42403 0 $114.00 DESCRIPTION ACCOUNT QTY AMOUNT NON-RESIDENTIAL, FIRST 2,000SF, PC 101-0000-42600 0 $88.16 Total Paid for ELECTRICAL - NEW CONSTRUCTION:. $346.55 DESCRIPTION ACCOUNT QTY AMOUNT AIR HANDLER 101-0000-42402 0 $342.00 DESCRIPTION ACCOUNT QTY AMOUNT AIR HANDLER PC 101-0000-42600 0 $114.03 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR 101-0000-42402 0 $266.00 DESCRIPTION ACCOUNT QTY AMOUNT CONDENSER/COMPRESSOR PC 101-0000-42600 0 $177.31 DESCRIPTION ACCOUNT QTY AMOUNT VENT FAN 101-0000-42402 0 $101.36 DESCRIPTION ACCOUNT- QTY AMOUNT VENT FAN PC 101-0000142600 0 $40.56 Total Paid for MECHANICAL: $1,041.26. DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PERMIT 101-0000-42400 0 $751.71. Total Paid for NEW CONSTRUCTION PERMIT: $751.71- 751.71DESCRIPTION DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PLAN CHECK . 101-0000-42600 0 $117.35 DESCRIPTION ACCOUNT QTY AMOUNT NEW CONSTRUCTION PLAN CHECK 101-0000-42600 0 $1,500.00 Total Paid for NEW CONSTRUCTION PLAN CHECK: $1,617.35 DESCRIPTION ACCOUNT QTY AMOUNT. BACKFLOW DEVICE 101-0000-42401 0- $12.67 DESCRIPTION ACCOUNT QTY AMOUNT BACKFLOW DEVICE PC 101-0000-42600 0 -$5.07 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER 101-0000-42401 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT BUILDING SEWER PC 101-0000-42600 0 $17.73 DESCRIPTION ACCOUNT QTY' AMOUNT FIXTURE/TRAP 101-0000-42401 0 $329.42 DESCRIPTION ACCOUNT QTY AMOUNT FIXTURE/TRAP PC 101-0000-42600 0 $329.42 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 1-4 OUTLETS 101-0000-42401 0 $12.67 DESCRIPTION ACCOUNT QTY AMOUNT GAS SYSTEM, 1-4 OUTLETS PC 101-0000-42600 0 $25.33 DESCRIPTION ACCOUNT QTY AMOUNT ROOF DRAIN 101-0000-42401 0 $177.38 DESCRIPTION ACCOUNT QTY AMOUNT ROOF DRAIN PC 101-0000-42600 0 $177.38 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: $1,158.01 DESCRIPTION ACCOUNT QTY AMOUNT SMI - COMMERCIAL 101-0000-20308 0 $123.31. Total Paid for STRONG MOTION INSTRUMENTATION SMI: $123.31 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for•TECHNOLOGY ENHANCEMENT FEE: $5.00 DESCRIPTION ACCOUNT QTY AMOUNT .OFFICE BUILDING 224-0000-20320 0 $28;758.95 Total Paid for TUMF - OFFICE: $28,758.95