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04-7583 (RC)Titf 4 4 a" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT Application Number . . . Property Address . . . . APN : Application description Property Zoning . . . . . Application valuation . . Owner KLEINE NEIL WAYNE 41910 BOARDWALK A-10 PALM DESERT PALM DESERT CA 92211 BUILDING & SAFETY DEPARTMENT (760) •777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 04-00007583 Date 12/03/04 79400 HIGHWAY 111 649-820-002- - - REMODEL - COMMERCIAL REGIONAL COMMERCIAL 154320 Contractor KLEINE BUILDING AND DEV INC 41910 BOARDWALK, SUITE A-10 PALM DESERT CA 92211 (760) 776-4840 WCC: STATE FUND WC: 1769113 12/01/0E CSLB: 390365 03/31/0E CCC: B-C27 ------- Structure Information REVISION TO SHELL BUILDING ----- Construction Type . . . . . TYPE V - NON RATED Occupancy Type . . . . . . BUSINESS <50 Flood Zone . . . . . . . . NON -AO FLOOD ZONE Other struct info . . . . . CODE EDITION 2001 CBC FIRE SPRINKLERS YES MIXED -USE OCCUPANCY B ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 832.00 Plan Check Fee 540.80 Issue Date Valuation 154320 Qty Unit Charge Per Extension BASE FEE 639.50 55.00 3.5000 THOU BLDG 100,001-500,000 192.50 Permit . . . . . . ELECT - ADD/ALT/REM Additional desc . Permit Fee . . . . 56.40 Plan Check Fee 14.10 Issue Date . . . . Valuation 0 Qty Unit Charge Per Extension BASE FEE 15.00 92.00 .4500 EA ELEC DEVICE/FIXTURE >20 -41.40 Permit MECHANICAL Additional desc Permit Fee 24.00 Plan Check Fee 6.00 Issue Date . . . . Valuation 0 P.O. Box 1504 * VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT ' ; Application Number: C1—S Applicant: Applicant's Mailing Address: Y Architect or Engineer: Architect or Lic. No.: BUILDING PERMIT DECLARATIONS Date: LICENSED CONTRACTOR'S DECLARATION I hereby affinn under penalty of perjury that I am licensed under provision+ I C- pte 9 (comment eclion 7000) of Division 3 of the Business and Professionals Code, and my Llcen License Class I i full force and effect License No.Date Z ContractorLIE-"c- OWNER.SUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5. Business and Professions Code: Any city or county that requires a pernlI to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant far the permit to rile a signed statement that he or she is licensed pursuant to the provisions of the Contractors' 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).): U 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 Cade: The Contractors' Stale License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or 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 wi11 have the burden of proving that he or she did not build or improve for the purpose of sale.). [j 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 bullds or Improves Ihareon, and who contracts for the projects with a cantractor(s) licensed pursuant to the Contractors' Slate Lfcense Law.). �) I am exempt under Sec. , B.& P.C. for this reason Date WORKERS' 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 work for which this permit is issued. 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 ss . My workers' compensation insurance carrierrier nd Ii y rlytm �p�y rlylm bpi Carrier Policy Number GG erty that, in the performance of the work for which�s e I l is u d, l all not employ } is a d. I all not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I outd become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Data &o4 Applicant WARNING: FAILURE TO SECURE WO�,ANDA7TOR(NEY'S N COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TI-O SAN0,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IN RE FEES. 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 APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Buiiding and Safety 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 ben ofit work is performed under or pursuant to any permit issued as a result of Ibis application, the owner, and the applicant, each agrees to, and shall, defend, indemnity and hold harmless the City of La QulnIa, its officers, agents and employees for any act or omission related to the work being performed under or fallowing 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 1a0 days will subject permit to cancellation. I certify that I have read this application and state that the above Information is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereb authorize representatives of this county to enter upon the above -mentioned property for inspectlon purposes. Date - Signature (Applicant or Agent— j: Page 2 Application Number 04-00007583 Date 12/03/04 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 . . . . 105.00 Plan Check Fee 26.25 Issue Date . . . . Valuation . . . 0 Qty Unit: Charge Per Extension BASE FEE 15.00 8.00 6.0000 EA PLB FIXTURE 48.00 4.00 7.5000 EA PLB WATER HEATER/VENT 30.00 4.00 3.0000 EA PLB WATER INST/ALT/REP 12.00 ---------------------------------------------------------------------------- Special Notes and Comments revision to existing shell building. each unit will require a tenant improvement permit.before move -in. 12/ 3/04 1:53:31 PM jjohnson ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STRONG MOTION (SMI) - COM 32.40 Fee summary ----------------- Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid 1017.40 .00 587.15 .00 32.40 .00 1636.95 .00 Credited Due .00 1017.40 .00 587.15 .00 32.40 .00 1636.95