04-6595 (RC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: f04r0 00 06595—�–'
Property Address: 17_8825 HIGHWAY 111_
APN: 643-020-999-4 -30903 -
Application description: REMODEL - COMMERCIAL
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 30000
Applicant: Architect or Engineer:
�Irro�
C
• 4.Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
WASHINGTON 111 LTD
C/O JOHN ANDERHOLT
P O BOX 1623
PALM DESERT, CA 92261
DA ntractor:
CIFIC COAST INDUSTRIAL INST
DEC 20-2004 0 EAST 15TH
N WPORT BEACH, CA 92663
CITY OF LAaUINTA 49) 646-2121
ctlumiconemT L c. No.: 754639
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: D21 -D24 LicenseNo.: 754639
con
ra l V
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 subjects the applicant to a civil penalty of not more than five hundred dollars 1$5001.:
(_ 1 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 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:
LQPERM[T
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 12/20/04
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:
Carrier STATE FUND Policy Number 0460011462
1 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(6qde, I shall f ith comply with those provisions. '
Date: / D Applicant: • j (�� e.,/ZSL�
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.
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 information is correct. 1 agree to comply with all
city and county ordinances and state laws relating to building construction, and hereby authorize representatives
ofthis county to enter upon the above-mentioned pr perty r inspec/ y�'�p� urposes.
_tJ^Date:) -Signature (Applicant or Agent): C%_ �T C -X A J
LQPERMIT
Application Number . . . . . 04-00006595
------ Structure Information STORAGE RACKS
-----
Construction Type . . . . . TYPE V -NON RATED
Other struct info . . . CODE EDITION
----------------------------------------------------------------------------
2001
Permit . . . BUILDING PERMIT
Additional desc .
Permit Fee . . . . 284.50 Plan Check
Fee
184.93
Issue Date . . . . Valuation
. . .
. 30000
Qty Unit Charge Per
Extension
BASE FEE
252.00
5.00 6.5000 THOU BLDG 25,001-50,000
32.50
----------------------------------------------------------------------------
Special Notes and Comments
Interior storage racks and retail
merchandise fixtures.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STRONG MOTION `(SMI)
- COM
6.30
Fee summary Charged Paid Credited
-----------------
Due
------------------------------
Permit Fee Total 284.50 .00
----------
.00
284.50
Plan Check Total 184.93 .00
.00
184.93
Other Fee Total 6.30 .00
.00
6.30
Grand Total ,475.73. .00
.00
475.73 "
LQPERMIT
CITY OF LA QUINTA
PLAN CHECK CORRECTION LIST
Circuit City
78-825 Hwy III
La Quinta, CA
PLAN CHECK NO. 04-6595 FINAL CHECK
ADDRESS :.Ji7&825 Hwy III OCCUPANCY M
SCOPE OF WORK Storage Racks TYPE -OF -CONST. III
October 11, 2004
The submitted plans and specifications have been rev-iewed by the VCA CODE GROUP. In our
professional opinion the plans are in substantial conformance with the building codes and regulations
adopted by the CITY OF LA QUINTAand the State of California Amendment.
APPROVAL FOR A BUILDING PERMIT IS HEREBY RECOMMENDED SUBJECT TO. OBTAINING
APPROVALS/CLEARANCES FROM ALL APPLICABLE CITY DEPARTMENTS, AGENCIES, AND
ASSOCIATIONS.
Plans checked by: Neil Evans, PE
VCA CODE GROUP
2200 W. Orangewood Avenue, Suite 155
Orange, CA 92868
(714) 363-4700 ext. 750
I
1
A
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VCA File No. LQ -16868