BCOM2015-002778-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
4
COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Application Number:
BCOM2015-0027
Property Address:
79315 HIGHWAY 111
APN:•
600020029
Application Description:
OLD SAMS CLUB/FIRE DAMAGE REPAIR
Property Zoning:
Application Valuation:
$100,000.00
Applicant:
JON K TAKATA CORPORATION DB'A R
4142 POINT EDEN WAY
HAYWARD, CA 94545
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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: C15, B License No.: 765595
Date: Contractor: VMC
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.).
(1 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 contractors) 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
Lender's
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 6/23/2015
Owner:
CENTRE AT LA QUINTA PARTNERS
3 HAMILTON LANDING NO 200
NOVATO, CA 92253
Contractor:
JON K TAKATA CORPORATION DBA R
4142 POINT EDEN.WAY
HAYWARD, CA 94545
(800)400-5058
Llc. No.: 765595
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 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 issued. My workers' compensation insurance carrier and policy number are:
Car ' r: Policy Number: _
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 3700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: (o-,93'ar Applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPEN TI N COVE AUGLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CI 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 nter upon the above•
mentioned property for inspection purposes.
Date: r� J f Signature (Applicant or Agent):
FINANCIAL INFORMATION
DESCRIPTION ACCOUNT '' ; QTY AMOUNT'. PAID DATE'
BSAS SB1473 FEE
101-0000-20306
0
$4.00
$0.00
PAID BY ,;:;METHOD'.:+.
RECEIPT#
CHECK
CLTD BY
Total Paid forBUILDING STANDARDS ADMINISTRATION BSA $4.00 ' $0.00
w DESCRIPTION ;
;ACCOUNT
QTY.,
AMOUNT;';
�L1PA10 ° ° � `
PAID DATE
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$1083S
$0.00
° PAID; BY
METHODF < `
RECEIPT #
z,
"'f`'CHECK #"'
,CLTDYBY,
" _ DESCRIPTION
ACCOUNT ' , ;
CITY
AMOUNTn `'°
`` *PAID <
P'AID'DATE
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$87.00
$0.00
PAID BY 'u 2
1 �^`:.. METHOD . ` .
1 "' RECEIPT # + `.
n CHECK #f s'a
CLTD BY s,
DESCRIPTION" z"
ACCOUNTQTY`
'AMOUNT`:
kPAID s:'PAID+DATE
REMODEL, FIRST 100 SF
101-0000-42400
0
$49.31
$0.00
3 PAID BY
;METHOD
RECEIPT # 1
CHECK # ° '°CLTD
BY
DESCRIPTION '
ACCOUNT,:
QTY.AMOUNT.
�.
"'PAID
PAID DATE
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$134.88
$0.00
„ PAID'yBY z'
_ METHOD ` ,
RECEIPT #
CHECK # <° `'.
€CLTD BY,
Total Paid for REMODEL: $379.94 $0.00
DESCRIPTION
,; ACCOUNT } fi - e"
QTY
AMOUNT '
PAID,
PAID.DATE
„
'
SMI - COMMERCIAL
101-0000-20308
0
$28.00
$0.00
PAID BY _• ;; , 1
.=,METHOD ;` ,,
RECEIPT #
CHECK*
CLTD BY -
Total Paid forSTRONG MOTION INSTRUMENTATION SMI $28.00 $0.00
TOTALS:•4 $0.00
♦. t
1
r
*' Permit Details u PERMIT NUMBER ,
City of La Quinfa BCOMT20150027
ADDITIONAL
CHRONOLOGY
CHRONOLOGY TYPE STAFF NAME ACTION DATE , COMPLETLON DATE`. = NOTES
- xn _ .. w _ a ._..
EMAILED KATHRYN AT YES TO REQUEST A COMPLETENESS
- E-MAIL
AJ ORTEGA
, ' 4/23/2015
4/23/2015
REVIEW AND DETERMINE IF THE SUBMITTED DOCUMENTS
ARE ENOUGH TO ISSUE A PERMIT FOR THE REPAIR WORK
NECESSARY:
-
EMAILED DENNIS WITH DESERT ENGINEERS THAT OUR
STRUCTURAL CONSULTANT APPROVED THE OBSERVATION
REPORT AND STRUCTURAL DRAWINGS. ATTACHED THE
E-MAIL, `
AJ ORTEGA
. 4/28/2015
4/28/2015
DRAWINGS SO HE COULD HAVE THEM PRINTED AND WET -
SIGNED IF NECESSARY FROM BRIAN GOTTLIEB. ALSO
k
ATTACHED A BUILDING APPLICATION THAT IS NECESSARY TO
BE COMPLETED PRIOR TO BEING ABLE TO ISSUE THE PERMIT.
CONTRACTOR CAME IN WITH FOR SIGNED PLANS FOR
PUBLIC COUNTER VISIT
AJ ORTEGA
6/16/2015
6/16/2015
APPROVAL, ALL REMAINING ITEMS CLEARED, OK TO ISSUE.
UPDATED WORKMENS COMP ATTACHED TO LICENSE RECORD
Printed: Tuesday, June 23, 2015 1:08:14 PM - .1 of 4 `.
SYSTEMS
Permit Details PERMIT NUMBER `.
v -City of La Quinta BCOM015=0027
CONDITIONS
CONTACTS
NAME TYPE
- NAME ADDRES51
CITY
STATE.
ZIP ' _ PHONE , . r FAX : , - :EMAIL.
APPLICANT
JON K TAKATA CORPORATION DBA R
4142 POINT EDEN WAY
HAYWARD
CA
94545
CONTRACTOR
JON K TAKATA CORPORATION DBA R
4142 POINT EDEN WAY
HAYWARD
CA
94545
OWNER
CENTRE AT LA QUINTA PARTNERS
3 HAMILTON LANDING
NOVATO
CA
92253
NO 200
FINANCIAL
• • •
y __.._
; DESCRIPTION � ACCOUNT QTY3 AMOUNT
• r. �N.: CLTD
:PAID RPAID DATE RECEIPT # CHECK #; METHOD PAID BY,-, ' BY m
_ _
»u+ .."-
.. . .. a a , p ,.. .• .. -
_ d
BSAS.SB1473 FEE
101-0000-20306 0 $4.00
$0.00
Total Paid forBUILDING STANDARDS ADMINISTRATION
$4.00 $0.00 ..
BSA:
REMODEL, EA
101-0000-42400
0
$108.75
$0.00
ADDITIONAL 500 SF
REMODEL, EA
101=0000-42600
0
$87.00
$0.00
ADDITIONAL 500 SF PC
REMODEL, FIRST 100 SF
101-0000-42400
0
$49.31
$0.00
REMODEL, FIRST 500 SF
101-0000-42600
0
$134.88
$0.00
PC
Total Paid for REMODEL: $379.94 $0.00 —
SMI -COMMERCIAL
161-0000-20308
0
$28.00
$0.00
Total Paid forSTRONG MOTION INSTRUMENTATION SMt $28.00 $0.00
TOTALS:•4 $0.00
Printed: Tuesday, June 23, 2015 1:08:14 PM 2 of 4
SYSTEMS
.-REVIEW TYPE-
.
PREVIEWER "
SENT DATE
DUE DATE '
RETURNED
'DATE
STATUS,
REMARKS '
-NOTES
SEE CHRONOLOGY EMAILS, WAITING FOR
- NON-STRUCTURAL
AJ ORTEGA
4/23/2015
5/7/2015
4/28/2015
READY FOR APPROVAL
APPLICANT TO RETURN WITH PAPER COPIES OF
.
THE APPROVED PLAN AND AN APPLICATION
PRIOR TO BEING ABLE TO ISSUE PERMIT.
STRUCTURAL
KATHRYN
4/23/2015
5/7/2015
4/28/2015
APPROVED
SEE ATTACHED TRANSMITTAL
SAM UELS
BOND INFORMATION
ATTACHMENTS
'AttachmentlT pe CREATED OWNER •w y' `DESCRIPTION PATHNAME
SUBDIR ETRAKIT,ENABLED
STRUCTURAL
BCOM2015-0027 -
DOC
4/23/2015
AJ ORTEGA
DRAWINGS (ORIGINAL`
STRUCTURAL
0
DRAWINGS (ORIGINAL
APPROVED)
APPROVED).pdf
BCOM2015-0027 -
DOC
4/23/2015
AJ ORTEGA
STRUCTURAL
STRUCTURAL
0
OBSERVATION AND FIX
OBSERVATION AND
1
FIX.pdf
BCOM2015-0027 -
DOC
4/28/2015
AJ ORTEGA
COMPLETE DRAWINGS
COMPLETE
0
DRAWINGS.pdf
BCOM2015-0027 -
STRUCTURAL
STRUCTURAL
DOC
4/28/2015
AJ ORTEGA
OBSERVATION AND FIX
OBSERVATION AND FIX
0
(STAMPED APPROVED)
(STAMPED
APPROVED).pdf
BCOM2015-0027 -
DOC
4/28/2015
Al ORTEGA
COMPLETE DRAWINGS
COMPLETE DRAWINGS
0
(STAMPED APPROVED)
(STAMPED
APPROVED).pdf
Printed: Tuesday, June 23, 2015 1:08:14 PM 3 of 4
COWsYSTEMS'
r
Bin #
City of La Quinta
00P & Building Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012.
Building Permit Application and Tracking Sheet
Permit #
WOO(T "
Project Address: —15 i W14
Owner's Name:
A. P. Number:
Address: (0?h 61-WO SIJRN
Legal Description:
City, ST, Zip:
Contractor:
telephone:
Address: 0f), �� h
Project Description:
City, ST, Zip: LJ64-✓Ld C
Telephone: a'Z
State Lic. # : 7
City Lie. #:
Arch., Engr., Designer:
Address: -75" of C!? f C� (-
City, ST, Zip: �� N
Telephone: one: 07O
State Lic. #
Con structi n Type: e•
'�to Occupancy: �
Project hPa (circle one):
: New Add'n Alter e A airDe m 0
Name of Contact Person: ��.�� I •�
Sq. Ft.: .1�5 oD
# Stories:
# Units: C
Telephone # of Contact Person: AVV-6
cs O
Estimated Value of Project: % ®Oj 6L0J0 ..
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Cales.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2". Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
'^' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees