10-0808 (RC)T-&t 4
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: 8/31/10
Application Number: 10-00000808 Owner:
Property Address: 45280 SEELEY DR EISENHOWER MEDICAL CENTER
APN: 604-630-025- - - 39000 BOB HOPE DR
Application description: REMODEL - COMMERCIAL RANCHO MIRAGE, CA 92270
Property Zoning: TOURIST COMMERCIAL
Application valuation: 16000 --_
Contractor: Fj
Applicant: Architect or Engineer: WDL CONSTRUCTION Fkt r �3
74075 EL PASEO, 22010
SUITE BC tI
PALM DESERT, CA 92260
(760)674-9553 F ui
Lic. No.: 741137T
-------------------------------------------- ----------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of per41aed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the sional Code, and my License is in full force and effect.
License Class:B icenseNo.: 741137
Date:(6 Contractor:
R-BUILDER DECLARATION
I hereby affirm under penalty pept 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).:
(_) 1, 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 _ 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 contractor(s) 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 Name: _
Lender's Address:
LQPERMIT
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:
Carrier DELOS INS Policy Number 01DKRM12007667
I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
person in any manner so as to beco subject to the rkers' compensation laws of California,
and agree that, if I should beco subject to the keys' pensation provisions of Section
i3700 of the Labor Code, I forth h co wit e provisions.
Date: `711114* Applicant:
m
WARNING: FAILURE TO SECU WORKERS' COM ENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT 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 Director of Building 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 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 inf&ffnation is correct. Oto comply with all
city and county ordinances and state laws relating to building c ruction, and h thorize representatives
of this county to enter upon the above -mentioned property f asp tion pur
ate: ! ldo Signature (Applicant or Agent):
Application Number . . . . . 10-00000808
------ Structure Information PROCEDURE ROOM LIGHTING REVISIONS -----
Other struct info . . . . . CODE EDITION 2007/2008
FIRE SPRINKLERS FULLY
MIXED -USE OCCUPANCY B
----------------------------------------------------------------------------
Permit . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 171.00 Plan Check Fee 111.15
Issue Date . . . . Valuation . . . . 16000
Expiration Date . . 2/27/11
Qty Unit Charge Per Extension
BASE FEE 45.00
14.00 9.0000 THOU BLDG 2,001-25,000 126.00
----------------------------------------------------------------------------
Permit . . . ELECT - ADD/ALT/REM
Additional desc . .
Permit Fee . . . . 18.00 Plan Check Fee 4.50
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 2/27/11
Qty Unit Charge Per Extension
BASE FEE 15.00
4.00 .7500 PER ELEC DEVICE/FIXTURE 1ST 20 3.00
------------------------------- ----
Special Notes and Comments
PROCEDURE ROOM LIGHTING REVISIONS AT (4)
LOCATIONS - ROOMS: A128, A306, B330 AND
C329. MAQUET LUCEA LED FIXTURES TYPICAL.
2007/2008 CALIFORNIA BUILDING CODES.
August 31, 2010 4:45:51 PM AORTEGA
----------------------------------------------------------------------------
Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00
ENERGY REVIEW FEE 11.11
Fee summary Charged
Permit Fee Total 189.00
Plan Check Total 115.65
Other Fee Total 12.11
Grand Total 316.76
Paid Credited Due
.00 .00 189.00
.00 .00 115.65
.00 .00 12.11
.00 .00 316.76
LQPERMTr
Q
r
rn
rn
w
x
>
w
U
O
t9
U
0
Z
Q
T
a
U
W
Q
W
J
r
J
3
W
Q
Q
U
OS
U)
Z
�
S
W
o
_
v
U
O
W
M
O
r
(r
(L
(1)
w
7
Q
J
m
3
3:
O
J
O
LL
O
r
a
O
Q
S
Q
r
r
z
Q
F-
r
0
Z
J
U
Z
U)
w
0
a
a
x
a
LL
�I
0
w
r
0)
W
uj
w
In
a
w
W
LU
Y
K
O
LL
U)
O
O
LL
Q
O
w
a
a
a
Ir
O
LL
0
O
U
z
O_
r
U
a
z
O
N
w
U
r
x
0
J
w
x
0
w
U
N
0
Y
O'
¢.
Q
I
g
w
W
Z
K
a
S
Z
U
O
r
r
CL
W
K
IL
U
r
U)
y
W
O
0
(L
0
0
w
�
I'
o
¢
O
U)
IL
I1
O
H
U
0)
M
O
U)
J
LL
O
LL
ca
m
y
LLI
Ir
u:
co
w
It
0
O
Z
O
0
uj
m w
0
w O
� U
o w
0 IA J
w O U.
F
O
Z LL
-U W
o r �
w O
?� z y
w r O
> J J
W
U
Z Z
W
U Y
0 =
w O _r
w w 3
r
> O
K Z
rn
o a
z
r
m O
0 z
3 W
w K
> a
w to
W
6 O'
w �
O N
O O U O
J r
z U
O z )-
w I1
U LL O
Q _ U
11
m
m
E