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08-1157 (RC)P.O. BOX 1504 VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 • BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 8/28/08 Application•Number: 08-00001157 Owner: Property Address: 494'99 EISENHOWER DR KSL DESERT RESORTS ' INC APN: - 658-190-011-30 -28545 50905 AVENIDA BERMUDAS Application description:j REMODEL - COMMERCIAL LA QUINTA, CA 92253 Property Zoning: TOURIST COMMERCIAL Other struct info C Application valuation: ,40000 Contractor: D 4 Applicant: Architect or Engineer: Owner �,)EP 0 2009 DITION 2 Lic: No.: --------- -----CITY OF ....J r. FIIVAFS� LEP7- ._. . • LICENSED CONTRACTOR'S DECLARATIONWORKER'S COMPENSATION DECLARATION Ihereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: _ Section•7000j of Division 3 of the Business and Professionals Coder and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: License No.: - - — - - - - - - - - - - - for by Sectiori 3700 of the Labor Code, for the performance of the work for which this permit is, issued. Date: - Contractor: _ 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 OWNER -BUILDER DECLARATION : insurance carrier and policy number are: I -hereby affirm under penalty ofperjury that'I am. exempt from the Contractor's State License Law for the- Carrier YES - Policy Number ANCY� M ..,following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any . construct, alter, improve, demolish, or repair any structure; prior to its issuance; also requires the applicant for the person in any manner so as to become subject to the workers' compensation laws of California, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become subject to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Section 7000) of Division 3-of the Business and Professions Code) or 01G 00 of theLabor Code, I shall forthwithcomplywith-those provisions.that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by r� - any applicant for a permit subjects the applicant to a civil penaltyof not more than five hundred dollars ($500).: Date:Q Applicant: (1 1, as, owner of the property, or my employees with wages as their sole compensation, will do the work; andthestructure is not intended or offered for'sale (Sec. 7044, Business and Professions Code: The WARAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or improves thereon, SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND 'and who does the work himself or herself through his or her own employees, provided that the DOLLARS 1$100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN improvements are not intended or offered for sale. If, however, the building or improvement is sold within SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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.). ` APPLICANT ACKNOWLEDGEMENT ' \ I,.as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the 7044, Business and Professions Code: The Contractors' State License Law does not apply to an,owner-of conditions and restrictions set -forth on this application. .. property who builds or improves thereon, and who contracts for the projects with a contractor(s)'licensed 1. -Each person upon whose behalf this application is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is perfornied.under or pursuant to any.permit issued as a result of this application, (_) I am exempt under Sec. , B.&P.C. for this reason the owner, and the applicant, each abiees to, and shall defend, indemnify and hold harmless the City 00 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.' , Date:--- - - _o Owner: - 2. .Anypermit 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 CONSTRUCTION ENDING AGENC - - permit to cancellation. i 1 hereby affirm under penalty of perjury that there is a constructiop lending agency for the performance of the I certify that I have read this application and state that the above informaiion'is correct. I agree to comply with all work for which this permit is issued (Sec. 3097, Civ. C.). ` _ city aocouty ordinances and state laws relating to buil 'ng cttclion��arij!-ISreby authorize representatives. of thenter upon the above -mentioned grope for rpLender's Name: !"`-.`."'* ^--DateSignature (Applicant or Agent): ;Lender's.Address: LQPERA1IT r Application Number . . . . . .08-00001157 Permit BUILDING PERMIT Additional desc . Permit Fee . . . . -349.50 Plan Check Fee 227.18 Issue Date Valuation . . . . 40000 Expiration Date 2/24/09 Qty Unit Charge Per Extension BASE FEE 252.00 15.00 6.5000 ------------------------------------------------------------------------------ THOU BLDG 25,001-50,000 97.50 Permit . . . ELECT - ADD/ALT/REM Additional desc.. Permit Fee 41.76 Plan -Check Fee 10.44 Issue Date Valuation 0 Expiration Date 2/24/09 Qty Unit Charge Per Extension BASE FEE 15.00, 1338.00 .0200 ---------------------------------------------------------------------------- ELEC GARAGE OR NON-RESIDENTIAL 26.76 Permit MECHANICAL Additional desc . Permit Fee . . . . 24.00 Plan Check Fee•. 6.00 Issue Date Valuation . . . . 0 Expiration Date 2/24/09. Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH APPL REP/ALT/ADD 9.00 Permit PLUMBING Additional desc . Permit Fee : . . . 61.50 Plan Check Fee 15.38 Issue Date Valuation 0 Expiration Date 2/24/09. Qty Unit Charge Per Extension BASE FEE 15,00 6.00 6.0000 EA, PLB FIXTURE 36.00 1.00 7.5000 EA PLB WATER HEATER/VENT 7.50_ 1.00 3.0000 EA PLB WATER INST/ALT/REP.. 3.00 ---------------------------------------------------------------------------- Special Notes and Comments RELOCATE EXISTING SERVICE EQUIPMENT FOR LQPERDIIT Application Number 08-00001157 Special Notes and Comments" COFFEE SHOP. INCLUDING ELEC. EQUIPMENT,COUNTERS,REPLUMB, RETILE FLOORS AND PAVERS.SQ. FTG AND OCCUPANT LOAD -WILL NOT.CHANGE. --------------------------------------------------------- Other Fees ... . . . . . . . "STRONG MOTION ------------------- (SMI) - COM 8.40 Fee su,Tnmary Charged Paid Credited Due Permit Fee Total 476.76 .00 .00 476.76 Plan Check Total 259.00 .00 .00 259.00 Other .Fee Total 8:40 .00 .00 8.40 Grand Total 744.16 .00 .00 744.16 t " e r LQPERIMIT CITY OF•LA QUINTASUB-CONTRACTOR LIST j< JOB ADDRESS "1Q-`1�a1 �,�S��ower O-< PERMIT NUMBER OWNER LA 121&. �(� qQ,:L BUILDER. Lt�_Q��ti- . Dicv �-� ,--� This form shall be posted on the job with the Building Inspection Card at all times in a. conspicuous place. 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 building permit. For each applicable trade, all information requested below must,be completEd by applicant. "On File" is not an acceptable response. Trade Classification / Class U ation C ra ont clot ::::: ::;:::::::: S a :. a ::::::..:: ' :.:.:...t te.Contr .clots. License... ::> `Workeis.Coni ensation::InsuranCe:;. >;;. ;. :.: City Biisnes License: Company Name Classification (e.g. A, B, C-8) License Number . (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) , Exp. Date (xx/xx/xx) License Number (xxxx) Exp, Date (xx/xx/xx) EARTHWORK (C712) CONCRETE (C-8) s FRAMING 'IC-51 .. STRUCT'. STEEL (6-51) MASONRY (C-29) ;. . PLUMBING (C-361 - \ 1 M / �'��f' '-� 3 g ?Joa f , 1 "> •� 0 LATH; PLASTER (C=35) DRYWALL (C-9) ,...-. HVAC. (E-20)-:.:: { off- ELECTRICAL. (C=10Y :. .: �C3`n. �� Q C. '�' Cr �ThC. �'' t® s a 2-3�- ROOFING'(C.=39) :`.`•:>�> . . -SHEET METAL (d 43) :' FLO04RING (Cl GLAZING (C-17);. INSULATION:`(C-2) .' SEWAGE DISP (C-42) .:= PAINTING (C=33) - CERAMIC TILE (C-54) CABINETS IC-61 it- yy 0�0055�yb$\ , 1 dQ t FENCING (C713) LANDSCAPING (0-27) .' POOL (C-53) . Riverside County Fire Department FirldProtection Planning Section Riverside office: 2300 Market SL, Ste. 150. Riverside, CA 92501 Ph. (951)955.4777 Fax (951) 9554886 Murrieta Office: 39493 Los Alamos Rd., Ste A, Murdete, CA 92563 Ph. (951) 600-6160 Fax (951) 600.6164 Palm Desert Office: 77.933 Las Montanas Rd., s 201 Palm Desert, CA 9221 1.4131 Ph. (760) 863-8886 (760) 863-7072 ' Fire Department Clearance/Release Date: To: Lj Qva l't• N 4 J f dq Fax: Tract/Parcel Map #: Perm it/Lot #: Job Site Add ress:d . r Final For Recordation Release For Building Permit(s) Shell Final Only (No Tenant) Final For Occupancy , j Building Plan Check Fees Paid Building Plan Check Fees•Not Paid Other Fees ' Fees Not Required, If you should have any questions, please contact the appropriate Riverside County Fire Protection Planning office for further assistance. Auth 'zing Signature FoY Aelease • Print Name COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH SERVICES SUPPLEMENTAL REPORT TO SAN. FORM # DATE SUBJECT ��^ ` � ^�� y2t " �l COC Fox / A 1 4 { PERMIT NO. 93 V ADDRESS r1 -' �) 1 �l C`� S �.p„�� f O C,c� W INSPECTOR Fo , �---� REMARKS: is v to h � "f r- -118 (Rev 8102). Distribution: WHITE---Office;.CANARY-Owner, PINK —Office