04-5798 (TT)BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO `. FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) ,777-7153
BUILDING PERMIT
Application Number . . . .
Property Address . . . . . .
APN :
Tenant. nbr, name . . . . . .
Application description .
Property Zoning . . . . .
Application valuation . . . .
Owner
WAL MART REALTY CO
DEPT 8013 RE: STORE # 1805
702 SW 8TH ST
BENTONVILLE AR 72716
04-000.05798 ,Date 8/02/04
78950 HIGHWAY 111
643-080-004-6 -000000
KOHLS CONSTR. TRAILER W/FENCING
TEMPORARY TRAILER
REGIONAL COMMERCIAL
4250
Contractor
NEAR CAL CORPORATION
512 CHANEY STREET
LAKE ELSINORE CA 92530
(909) 245-5400
WCC: STATE FUND
WC: 1669490 01/01/05
CSLB: 230077 01/31/05
CCC: A -B
-
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Permit TEMP TRAILER / MOBILE HOME
Additional desc . .
Permit Fee . . . . 200.00. Plan Check Fee .00
Issue Date . . . . Valuation 1.700
Qty Unit Charge Per Extension
BASE FEE 200.00
-------------------------
Permit . . . . . . WALL/FENCE PERMIT
Additional desc .
Permit Fee 72.00 Plan Check Fee .00
Issue Date Valuation 4250
Qty Unit Charge, Per Extension
BASE FEE 45.00
--------------------------------------
_----_-3_ --------
009_ -
9.0000 THOU BLDG 2,'001-25,000 27.00
--------------------------�---- --- - -------
Special Notes and Comments w
TEMPORARY CONSTRUCTION TRAILER WITH 500 O �^ QCJTO
LIN•FT. CHAIN LINK FENCING. TUP#04-471
2001 CODES
Fee summary Charged. Paid Cre i ec�FNaN Due
P.O. BOX 1504
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: Coq- 5798
Applicant:
Applicant's Mailing Address:
Date: 25—
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILUINU 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
C�de, and my Li c e full force and effect.
2
/Cicense Class icensa No. Z
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 fora 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
1 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. pyoworkers' compensation ms rance carrier an�f oli�.�(nu r e:
�rrier Spl,'a `1, in olicy Number_ l(nC% 1.��
I 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.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COARAGE 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 permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
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 Ouinta, 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 gre o comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county toenter up abo enti ed property for inspection purposes.
ate ignature (Applicant or Agent
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Date 8/02/04
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P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
August 3, 2004
(760) 777-7000
FAX (760) 777-7101
Mr. Ken Petrisko
Near -Cal Corp.
512Chaney Street
Lake Elsinore, CA 92530-2711
RE: Temporary Use Permit 2004-471
Construction office trailer at Kohl's Department Store - 78950 Highway 111
Dear Mr. Petrisko:
The Community Development Department has reviewed your application for the above
referenced Use Permit. Your request for a temporary construction trailer,. located as per
Exhibit A, is approved provided the following conditions are met:
General Conditions
1. The applicant/developer, agrees to indemnify, defend, and hold harmless the City of
La Quinta from any legal claim or litigation arising out of the City's approval of this
project. The City of La Quinta shall have the right to select its defense counsel at
its sole discretion.
Site Trailer:
- -:2 ___Install -one 2A106C fire extinguisher inside the trailer by the front exit door.
3. Any temporary lighting shall not be directed toward surrounding properties.
4. Applicant shall obtain a building permit, including an electrical permit as necessary,
for the trailer set-up.
5. This approval is for location of the office trailer and establishment of an
approximate 150 x 200 -foot fenced in storage/staging area. Trailer shall not be
located so as to block approved travel ways or required fire access during
construction activities. The site shall be kept clean and free of construction debris.
6. Parking for this use shall be restricted to existing street and parking areas within the
overall project site. =
7.. One 2' x 3' trailer -mounted sign shall be placed close to the front door, providing
emergency personnel a 24-hour emergency phone• number to contact in case
problems arise that need prompt attention (minimum 1 " high letters). The sign shall
include any temporary address, and may include the company name for the purpose
of identification.
S
8. Provide restroom facilities and handicapped access as may be required by Building
and Safety.
9. This Temporary Use Permit approval shall be limited to one year from the date of
this letter, at which time the use shall be or have been terminated, unless a written
extension request is received by the Community Development Department. No more
than a six-month extension period may be granted, to be reviewed upon receipt of
such written request for an extension.
The City may impose additional conditions to this application to mitigate any problems that
arise not previously addressed herein. This decision may be appealed to the Planning
Commission provided the necessary paperwork and filing fee of $175.00 are filed with
this office within 15 days of the date of approval.
If you have any questions, please contact me at 760-777-7069.
Very truly yours,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
bf
Wallace H. Nesbit r-
Associate Planner
Enclosure
c: Code Compliance
Fire Marshal
Counter Technician, Building & Safety .
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CLOTMESTIME
6-2 /( PAYLESS SHOE SOURCE
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TOTAL . PARKING
SOT AREA
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2� Gazes � �'tC 2d
Approved bl
Date
Heso # SITE SUMMARY
❑ Planning Commission
0554,223
❑ City Council
SF. PROGRAMMED BLDG. AREA
590,875 SF. BLDG.
Community Dev. Dept.
3
AREA WITH EXPANSION
3043 PARKING PROVIDED
Initials CsJ
5.5/1000 STALLS PROVIDED
Case No. �� 011"y ?'1
5.1/1000 WITH EXPANSION
Exhibit. A
*INCLUDES THE THEATRE FOOTPRINT ONLY
With Conditions t'l-R_ 4-M
W/-05/
AND DOES NOT INCLUDE THE MEZZANINE
EVEN, LA QU I NTA
MAY 111 & WASHINGTON STREET
'LA OUINTA, CALIFORNIA
A COMMERCIAL PROJECT BY.
4GTON/ADAMS PARTNERSHIP
71084 TAMARISK LANE
JCHO MIRAGE. CALIFORNIA 92270
MICHAEL J. SHOVLIN
(760) 324-5485
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ARCHITECTS
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