BCOM2020-000278-495 CALLE TAMPICO C� a D *PL(�Ci1
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype: BUILDING COMMERCIAL/REMODEL
Application Number:
BCOM2020-0002
Property Address:
78802 HIGHWAY 111
APN:
643080053
Application Description:
FIT IN 42 / 1,950 SF FITNESS GYM TENANT IMPROVEMENT
Property Zoning:
Application Valuation:
$1,000.00
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
JANICE MORGAN
Date: 2/10/2020
Applicant: Contractor:
GERRY WASHACK D
OWNER BUILDER
44711 SAN JACINTO AVE PALM DESERT,ca 92260 ,
FEB 10 2020 Du Llc. No.:
MY OF LA QUINTA
----------------------------- PESiGN&-DEVELOPMENT DEEMMENT ---------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter
9 {commencing with Section 70001 of Division 3 of the Business and Professions Code,
and my License is in full force and effect.
License Class: - License No.:
Date
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 bjec[s the applicant to a civil penalty of not more than five hundred dollars
A[5
I, as owner of the property, or my employees with wages as their sole
om nsation, will do the work, and the structure is not intended or offered for sale.
aec. 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 of intended or offered for sale. If, however, the building or improvement is sold
wi n one year of completion, the owner -builder will have the burden of proving that
Ithen,
not build or improve for the purpose of sale.)-
ner of the property, am exclusively contracting with licensed contractors
the project. (Sec. 7044, Business and Professions Code: The Contractors'
Law does not apply to an owner of property who builds or improves
who contracts for the projects with a contractor(s) licensed pursuant to
ors' State License Law.).
empt under Sec. B.&P.C. for this reason
Date: k Owner:
CONSTRUCTION LENINNG 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
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
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:
Carri r _ PalisyNumber:
AsI certify that in the performance of the work for which this permit Is issued, I
t 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: 3 Applicant: v J5;,7 1 w v V
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVVIAV*-IS UNLAWFUL;
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A1QD 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 I elating to building
construction, and hereby authorize representatives of this city o ent r
above -mentioned property for inspection purposes. _ o,�
Date: Signature (Applicant or Agent):
Date: 2/10/2020
Application Number:
Property Address:
APN:
Application Description
Property Zoning:
Application Valuation:
Applicant:
GERRY WASHACK
44711 SAN JACINTO AVE
PALM DESERT, ca 92260
BCO M 2020-0002
78802 HIGHWAY 111
643080053
FIT IN 42 / 1,950 SF FITNESS GYM TENANT IMPROVEMENT
$1,000.00
Owner:
JANICE MORGAN
Contractor:
OWNER BUILDER
Llc. No.
Detail: FIT IN 42 / 1,950 SF FITNESS GYM TENANT IMPROVEMENT [VB/B-OCC/20-OL/SPRINKLED]. DEMO EXISTING FLOOR RECEPTACLES AND INSTALL NEW
INTERIOR NON -BEARING PARTITION WALL PER CONVENTIONAL STEEL STUD DESIGNS TO CREATE LOBBY AREA. EXISTING EGRESS SYSTEM TO REMAIN
UNALTERED. THIS PERMIT DOES NOT INCLUDE ANY NEW ELECTRICAL, MECHANICAL OR PLUMBING INSTALLATIONS. PATH OF TRAVEL TO BE VERIFIED AS
FULLY COMPLIANT IN FIELD. 2019 CALIFORNIA BUILDING CODES.
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIRE COMMERCIALTI
101-0000-42421
0
$161.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
FIRE COMMERCIALTI PC
101-0000-42420
0
$242.00
Total Paid for FIRE FEES: $403.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
101-0000-42600
($80.50)
DESCRIPTION
ACCOUNT
CITY
AMOUNT
101-0000-42600
($44.00)
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PARTITION
101-0000-42400
0
$80.50
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PARTITION PC
101-0000-42600
0
$44.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
PARTITION PC
101-0000-42600
0
$104.12
Total Paid for PARTITION 2019: $104.12
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PLAN CHECK DEPOSIT-ADDITION/REMODEL
101-0000-42600
1
$125.00
Total Paid for PLAN CHECK DEPOSIT - ADDITION/REMODEL: $125.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
RECORDS MANAGEMENT FEE - MAJOR
101-0000-42416
0
$21.00
Total Paid for RECORDS MANAGEMENT FEE - MAJOR: $21.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
101-0000-42600
($0.50)
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI - COMMERCIAL
101-0000-20308
0
$0.50
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $0.00
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
ALTERATIONS/ADDITIONS - NON-RESIDENTIAL
101-0000-42400
0
$161.00
Total Paid for ZONING CLEARANCE - PLANNING PLAN CHECK: $161.00
PERMIT # pC00NW 1.Q ' 0 C0J,
PLAN LOCATION:
Project Address: N,a�� I
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
Applicant Name: G�.21L�( U-,ASRik-Cie..
Address:
9 (-? t 1 S
City, ST, Zip:
e�}'
Telephone:
Email:
' N2_ tzm
Valuation of Project $
Contractor Name: C
New SFD Construction:
c
Address:
Conditioned Space SF
City, St, Zip
Garage SF
Telephone:
Patio/Porch SF
Email:
Fire Sprinklers SF
State UT City Bus Lic;
Arch/Eng Name:
Construction Type: Occupancy:
Address;
Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories: # Units:
Email:
State Lic: City Bus Lic:
Property Owner's Name: 1i
n M!n
New Commercial / Tenant Improvements:
Address:
Total Building SF
City, ST, Zip �
Construction Type: Occupancy:
Telephone:
Email: ,!
,
78495 CALLE TAMPICO
LA QUINTA, CA 92253
760-777-7000
P.r
TW�t a(
DESIGN & DEVELOPMENT DEPARTMENT
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
(760) 777-7125 FAX (760) 777-7011
PATH OF TRAVEL UPGRADE DETERMINATION
DATE: T "
STATUS:
PLAN CHECKED BY:
TELEPHONE NUMBER:
ADDRESS: -7 lit
DESCRIPTION: /�%�.► UG �1
APPLICANT:
PLAN CHECK #:
In accordance with the 2016 California Building Code (CBC) Section 11B-202.4, exception 8, the cost of
compliance with Section 11B-202.4 is allowed to be limited to 20% of the adjusted construction cost of the
alterations, structural repairs or additions when the adjusted construction cost does not exceed the current
valuation threshold.
Construction cost for proposed project (not including costs of improvements to the path of travel to the
area of alteration): $ /, Coa (A)
Cost of alterations to areas on this path of travel undertaken during the preceding three-year period which
did not provide an accessible path of travel to the area of alteration (as applicable): $ (2 (B)
Adjusted construction cost (C) _ (A) + (B) $ l,�r;c G (C)
PATH OF TRAVEL CONSTRUCTION COSTS:
Elements serving the area of
Is element in If not, will element
Proposed cost of
alteration based on priority
compliance with be upgraded to
compliance with
current Chapter current Chapter
current
11B? (Y/N) 11B? (Y/N)
t
-T _
Chapter 11B
1. An accessible entrance
$
2. An accessible route (interior and
$
exterior) to the
altered area
i
3. At least one accessible restroom
$
for each gender or a single accessible
unisex, single user or family restroom
4. Accessible public telephones
$
5. Accessible drinking fountains
_
�_
$
6. When possible, additional
accessible elements such as:
a. Parking
r
$
b. Storage
$
c. Signs
y
$
d. Alarms
$
e. Other
$
Total cost of providing compliant
Q
$ (D)
path of travel elements:
COST OF PATH OF TRAVEL UPGRADES AS PERCENTAGE OF ADJUSTED CONSTRUCTION
COST:
Compliance of path of travel upgrades as % of adjusted construction
% (E)-
cost: (E)% = (D) / (C)
Note: This may not be less than 20%
Page 1of1
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LA QUINTA, CALIFORNIA 9 247.1504
78-495 CAI tE TAMPIC0
LA QUINIA, CALIFORNIA 92253
BUILDING & SATC=.I'Y DEPAl TNIFNT
PROPER'Ty OWNEWS PACKAGE
(760) 777-7012
FAX (760) 777-7011
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at
We are providing you with an Owner -Builder Acknowledgment and Infornmtion Verification Form to make you aware of your
responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have rend, initialed your understanding of each provision,
signed, and returned this form to us at our official address indicated. An agent of the owner cannot execute this notice
tnrless you, the property owner, obtain the prior approval of the pert -fitting authority.
OWNEWS ACKNOWLEDGMENTAND VERIFICATION OF INFORMATION
DIRECTIONS: Read and initial each statenfent below to signifj, you understand or verifv this infarn+ation.
1, 1 understand a frequent praeti..e of €rnlicenscd persons is to have the property owner obtain an "Owner -Builder"
building permit that erroneously implies that the property owner is providing his or tier own labor and inaterial personally. 1, as
an Owner -Builder, tnay be held liable and subject to serious f9,rancial risk for any injuries sustained by an unlicensed person
and his or her employees while working on my p€operty, My honreoivner's insurance may not provide coverage for those
injuries, I am willfully acting as an Owner -Builder and am aware of the litrrrts of my insurance coverage for injuries to workers
on my property.
_02. 1 understand building permits are neat mcluired to be signed by property owners unless they are responsible for the
construction and are riot hiring a licensed Contractor to assume this responsibility-.
_106 3. 1 understand as an "Owner —Builder" 1 a€rr the responsible party of tecord On the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
V#4. 1 understand Contractors are i'equired by law to be licensed and bonded in California and to list their license numbers on
permits and contracts.
* 5. 1 understand if employ or othetwise engage any persons, other thati California licensed Contractors, and the total value
of my construction is at least five Hundred dollars ($500), including labor and materials, I may be considered an "employer"
under state and federal law.
V6b. 1 understand if I am considered an "employer" under state and federal law, I must register with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment
compensation for each "employee." "1 also understand €ny failure to abide by these laws may subject me to serious financial
risk.
_e 7. 1 understand tinder California Contractors' State License Law, an O ner-Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless rill work is performed by licensed
subcontractors and the number of structures does not exceed four within any calendar year, or all of the work is performed
under contract witha. licensed general building Contractor.
0 8, 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for any
financial or personal injuries sustained by any subsequent owner(s) that result from any lateut construction defects in the
workmanship or inaterials.
'tom 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the internal Revenue
Service, the United States Small Business Adrainistration, the California Depw tment of Henefit Payments, mid the California
Division of Industrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1-
800-321-CSLB (2752) or www.cslb.ca.eov for more information about licensed contractors.
e10. 1. am aware of and consent to an Owner -Builder building p:rnut applied for in my name, and understand that I am the
party legally and financially responsible for proposed construction activity at the following address:
_"I 1. 1 agree that, as the party legal!'v and financially responsible for this proposed construction activity, I will abide by all
applicable laws and rerluirements that govern Owner -Builders as well as employers,
12.1 agree to notify the issuer of this Iizrrn immediately of any additions, deletions, or changes to any of the information I
have provided on this form, Licensed contractors are regulated by lases designed to protect the public. If you contract with
someone when floes not have a license, the Contractors' State License Hoard maybe unable to assist you with any fuwcial loss
you may sustain as a result of a complaint. Your only remedy against unlicensed Contractors may be in civil court. It is also
important for you to understand that if an unlicensed Contractor ar ttttp e of that individual or firm is injured while working
on your property, you may be held liable for damages. If you obtai t p t as Owner -Builder and wish to hire Contractors,
you will be responsible for verifying whether or not those Cron tars ar properly licensed and the status of their workers'
cornpensation insurance coverage.
Before a building permit can be issuers, this form must be meIeted signed by the property owner and returned to
the agency responsible for issuing the permit. t!'r�te: 6 P r€f tLle p tarry owner's driver's license, form rrntarizatiars, or
other verification acceptable to the agenc • is requir, d o Lae pr& ted when the permit is issued to veri& the PropelY
owner's signature. I
Signature of property owner — Date;tf
P.Al P_ 0
Note: Ae faLlowing Awhorization Form is required to be completed by the property owner only when designating
an agent of the property owner to applvjbr a construction permit.for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHAI.F
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize
the following person(s) to act as my agcant(s) to apply for, sign, and file the documents necessary to obtain an OxNrner-Builder
Permit for my project.
Scope of Construction Project (or Desc6ption of Work):
Project Location or Address: L 6vt L • ���r•�._(fr* 2 2 `� 3
Name of Authorized Agent: ` _�7,e - o-s Tel No 7 � Q ylS^ qy y O
Address of Authorizers Agent; y %� y� �� c /a (Ale _Pw �~y' 11re MJ l
d declare under penalty of perjury that I am the property ov►ni fir the address listed above and I personally filled out tine above
information and certify its accuracy. MoteA cr3,ay of the nar's drivers license, form notarization, or other verification
to the agency is required to be resrrrsrorl ry lithe p@rMit is issued to verii t, the pmperty owner's signature.
Property Owner's Signature: