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04-3937 (ELEC)T1Vf 4 4 Q" Fee summary --------------- Permit Fee Total Plan Check Total Grand Total Charged Paid Credited Due 30.00 .00 .00 30.00 .00 .0.0 .00 .00 30.00. .00 .00 30.00 I� u U MAY o 7 ?004 City aF QUiiii� I BUILDING& SAFETY DEPARTMENT P.O. Box 1504 c�AtOF.9 t (760),777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . . . 04--00003-937 Date 5/06/04 Property Address . . . . . 78805 HIGHWAY 111 APN: 643-020-999-4 -30903 - Application description ..'ELECTRICAL Property Zoning . . . . . . . REGIONAL COMMERCIAL Application valuation 1000 Owner Contractor WASHINGTON 111 LTD MOOREFIELD CONSTRUCTION,_ INC. C/O JOHN ANDERHOLT 3415 S. SEPULVEDA BLVD P 0 BOX 1623 LOS ANGELES CA 90034 PALM DESERT CA 92261 (310) 390-9400 WCC: STATE FUND WC: 1686016 03/31/05 CSLB: 397892 02/28/05 CCC: B ----------.--------------------'------------------------------------=--------- Permit . . . . . . ELEC-TEMPORARY POWER Additional desc k Permit Fee 30.00 Plan Check Fee .00 Issue Date Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA ----=----------------------.------------------------------------------------- ELEC TEMPORARY POWER POLE 15..00 Special Notes and Comments TEMP POWER PEDESTAL _ t Fee summary --------------- Permit Fee Total Plan Check Total Grand Total Charged Paid Credited Due 30.00 .00 .00 30.00 .00 .0.0 .00 .00 30.00. .00 .00 30.00 I� u U MAY o 7 ?004 City aF QUiiii� P.O. BOX 1504 • VOICE (760) ..77-7012 78-495 CALLE TAMPICO LA. QUINTA, CALIFORNIA 92253 FAX (760) 777-701 1 INSPECTIONS (760) 777-7153 „BUILDING & SAFETY DEPARTMENT Application Number: ef — -5 9 3 7 Applicant: C2 Toni Applicant's MailAddress: Date: 5 "�• � C% Architect o ngineer: ' Archit6ct or Engineer's Address: Lic. No.: MUILUINU PERMIT DECLARATIONS 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 Professionals 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 Contractors' 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 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 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 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 will have the burden of proving that he or she did not build or improve for the purpose of sale.). Q9 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. , BA P.C. for this reason 0/1 Date / . Owner [7! WORKERS' COMPENSATION DECLARATION 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 Policy Number I certity 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 worke' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the rsLabor Code, I shall forthwith comply with those provisions. Date Applicant WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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. 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 � �' Pe permit is issued (Sac. 3097, Civ. C.). Lender's Name Lenders Address IMPORTANT Application is hereby made to the Director of BuildingAPPLICANT aCKNOWLEDGEMENT 1. Each Safety permit subject to the conditions and restrictions set forth on this application. 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, indemnity 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 permit cessation of work for 180 days will subject 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 county to enter upon the above-mentioned property for inspection purposes. Date ��w f Signature (Applicant or Agent): _ X ,K/ MEMORll�ANDUM TO: DANNY CRAWFORD, BUILDING AND SAFETY DEPARTMENT FROM: FRED BAKER, PRINCIPAL PLANNER SUBJECT: TEMPORARY OCCUPANCY PERMIT FOR WASHINGTON MUTUAL BANK DATE: MAY 17, 2004 _.., The Community Development Department has walked through and reviewed the :- above project and the following corrections are necessary for a final occupancy permit: 1. Provide multi -color Texas Rangers or equivalent along landscape area located the west of the building,and the drive lane. Shrubs shall be planted five foot on center and allowed to grow to their maximum height for visual screening of the vehicle drive-through lane. 2. Box light fixtures shall be mounted in a fixed position with no allowance for adjustment. Should you have any questions, please call me at extension #7065. P:\FRED\Temp Occ memo.doc �'